以严重低血糖、反复呼吸心跳骤停为主症的甲状腺低功一例

患儿，男，52d，因呛奶5h。心跳、呼吸停止复苏后2h入院。患儿5h前吃奶后呛奶，随后面色青紫，呼吸不规则，拍背后面色及呼吸好转。1h后又面色青紫。呼吸微弱，大汗淋漓，随后呼吸心跳停止，在外院经气管插管，未吸出奶汁，胸外心脏按压，静推肾上腺素、阿托品、碳酸氢钠等抢救后心跳呼吸逐渐恢复。入院时查体：神志清。反应迟钝，面色稍苍白，四肢冰凉，可见花纹，毛细血管再充盈时间5～6s，自主呼吸30次／min，无吸气三凹征，双肺呼吸音清，未闻及哕音，心率118次／min、心律齐、心音低钝、无杂音，腹胀明显、叩诊鼓音，四肢肌张力稍低，膝反射正常，病理征未引出。辅助检查：腹部B超、头颅CT无异常。X光示：双肺透亮度稍减低，心影左移．双膈抬高，     

31例小儿反复心跳呼吸骤停及致死原因分析

对小儿尤其是婴幼儿若忽略了复苏后进一步处理和监测可发生反复骤停而死亡.本文对我院监护病房31例初步复苏后再次心跳呼吸骤停死亡者进行了分析,总结出临床上应当重视的致死直接原因.临床资料病例选择:1988年1月～1989年12月在监护病房     

先天性甲状腺机能减低症并心跳骤停1例

先天性甲状腺机能减低症并心跳骤停１例广东省汕头市中心医院儿科（５１５０３１）林寿伦患儿，女，３个月，足月顺产，哭声弱。食量少，喂养困难。常腹胀，便秘。１０天前开始咳嗽，伴有腹泻，为稀便。每天３次～４次。未见粘液血便。近２天来咳嗽加剧，反应差，辅助检查...     

静点红霉素致呼吸心跳骤停一例

6月女婴患支气管肺炎。入院后给用红霉素0.2g 加葡萄糖200ml 静点,并肌注丁胺卡那霉素,静点红霉素30分钟(约每分钟15滴)患儿气喘加剧,面色青灰,呼吸慢而不规则,半分钟后呼吸、心跳停止。以复苏,半分钟后呼吸心跳恢复。次日再次静点红霉素,20分钟后又出现上述情况,改用其他抗生素治疗,十余天后痊愈出院。     

利多卡因过敏致心跳呼吸骤停成功抢救一例

患儿,男,8岁.因“持续发热半个月”入院.入院后拟诊伤寒,心电图检查及肝、肾功能均正常.患儿无过敏史.入院后,准备行骨髓穿刺术,术前查体:T 37.6℃,R 25次/min,P 89次/min,BP 90/60 mm Hg(1 mm Hg =0.133 kPa),神志清楚,精神稍差,心肺查体未见异常,肝脾肋下未触及,未见病理征.骨髓穿刺术时,患儿仰卧位,取髂前上棘为穿刺点,术者常规消毒局部皮肤,戴无菌干手套,铺孔巾,给予2％盐酸利多卡因1.5ml局部麻醉至骨膜,应用利多卡因2 min后准备开始穿刺时,患儿突然呼吸心跳停止,颜面紫绀,神志不清,双侧瞳孔散大,血压未测出,SPO266％,初步判断为利多卡因过敏致心跳呼吸骤停.立即胸外心脏按压,口对口人工呼吸,气管插管,插管后简易呼吸器正压给氧,SpO2升至96％,同时给予肾上腺素1 mg,地塞米松10 mg,速尿20 mg静脉推注,抢救5min后心跳恢复,P 120次/min,10 min后患儿出现惊厥,给予咪唑安定1.5 mg静脉推注,用20％甘露醇125ml静脉快速点滴,防治脑水肿,插入导尿管,并给予冰帽降温.抢救30 min后双侧瞳孔渐正常大小,等大等圆,开始有不规则的自主呼吸,出现肢动,给予5％碳酸氢钠60ml静脉滴注,40 min后患儿神志完全恢复,呼吸正常,诉头痛,P 100次/min,R 20 次/min,BP 95/60 mm Hg,拔除气管插管,生命体征平稳后送返病房,随后抽取患儿静脉血样检测嗜酸粒细胞计数为0.58×109/L,IgE 368IU/ml,均明显升高,住院观察5d出院.     

暴发性心肌炎合并呼吸心跳骤停抢救成功一例

患儿,男,8岁.因"咳嗽10 d,发热5d,精神差1d,口周紫绀12 h"由急诊入院,既往健康.入院查体:体温不升,桡动脉触不到脉搏,呼吸45次/min,血压62/37mm Hg(1mmHg =0.133kPa),神志清楚,精神萎靡,呼吸急促,双侧瞳孔等大等圆,对光反射存在,口唇、口周紫绀,双肺呼吸音粗糙,心率123次/min,心律不齐,心音极低钝,无杂音,四肢末端凉.     

106例心跳呼吸骤停及心肺复苏

我科1986～1991年收治心跳呼吸骤停106例,其中男77例,女29例;新生儿54例,～3岁47例、～12岁5例。经复苏恢复有效心跳为即时存活16例(15.09%),存活出院为长期存活6例(5.71%),未恢复心跳为复苏无效90例     

溺水致呼吸心跳骤停85分钟抢救成功一例

患儿女,12岁,于2003年4月12日下午3:50不慎溺水(淡水)20余分钟,被救援人员抢救上岸,立即将患儿头低足高位,口中流出大量液体,神志不清,约10分钟路程送入我院急诊科。查体:脉博0次/min,呼吸0次/min,血压0mmHg,意识丧失,瞳孔散大,对光反射消失,四肢冰凉、发绀,心电监护示一条直线。诊断:重度溺水,呼吸、心跳骤停。立即气管插管,人工、机械呼吸(IPPV),胸外按压,建立静脉通道,反复静推肾上腺素,5 min 1次,剂量从1 mg逐渐增到3 mg,同时静推氨茶碱0·25共2次,阿托品、纳洛酮、地塞米松、碳酸氢钠等,入院1 h出现少许室性逸搏,继续肾上腺素、氨茶…     

维生素K1注射液致儿童呼吸心跳骤停一例

患儿,女,4岁,体重16 kg,因“咳嗽1周,加重伴喘息2 d”在我院门诊就医。查体：T 37．6℃, R 28次/min,P 93次/min,急性病容,神志清楚,咽部充血,双肺呼吸音粗,可闻及少许干鸣音及粗湿啰音,心音有力,心律齐,心率93次/min,心前区未闻及杂音。血常规示： WBC 12．6×109/L, N 80%,E 2%,L 18%,Hb 125 g/L,RBC 4．5×1012/L, PLT 350×109/L,C-反应蛋白35 mg/L。 X线胸片示：双肺纹理增粗、模糊,未见片状阴影。初步诊断为急性支气管炎。第1天门诊输液医嘱为“注射用五水头孢唑林1．0+生理盐水100 ml,静脉滴注,20滴/min ,每天1次”和“注射用炎琥林160 mg+5%葡萄糖注射液100 ml,静脉滴注,20滴/min,每天1次”治疗,当天输液过程无异常情况。患儿复诊述咳嗽、喘息无缓解,第2天输液医嘱除遵照第1天医嘱外,另加“维生素K1注射液10 mg +5%葡萄糖注射液100 ml,静脉滴注,20滴/min,每天1次”对症治疗。在静脉滴注维生素K1注射液2 min 时,患儿突然出现瘙痒、咽喉部不适(并有手抓喉部动作),随后出现面色青灰、口唇发绀、呼吸困难、烦躁不安等症状。病房巡回护士发现立即更换维生素K1注射液组液体,给予清理呼吸道、吸氧等对症处理,但患儿呼吸困难无缓解,神志渐模糊,继而呼吸微弱至停止,心跳减慢至停止。立即用简易人工呼吸器实施人工呼吸,同时持续胸外按压,并静脉推注“5%葡萄糖注射液5 ml+地塞米松磷酸钠注射液5 mg”和“生理盐水5 ml+盐酸肾上腺素注射液0．5 mg”及面罩吸氧等抢救措施。3 min后患儿呼吸心跳先后恢复,神志模糊,面色欠红润,可见吸气三凹征,考虑可能存在喉头水肿或(和)支气管痉挛,立即给予氧气驱动雾化吸入硫酸沙丁胺醇溶液2．5 mg+吸入布地奈德混悬液1 mg对症治疗,15 min再重复1次。整个抢救过程中患儿未出现皮疹,无抽搐发生。抢救30 min后查体：T 37．2℃,R 33次/min, P 136次/min, BP 92/60 mmHg (1 mmHg =0．133 kPa),神志清楚,面色稍红润,口唇无发绀,上唇肿胀明显,双肺可闻及少许粗湿啰音,心音有力,心律整齐,心率136次/min,心前区未闻及杂音。急查血电解质基本正常,血糖12 mmol/L,肝、肾功能及心肌酶谱均正常,心电图无异常发现。1周后复查时,患儿精神、食欲、自主活动正常,查体无异常发现,上述检查项目均正常。     

溺水致呼吸心跳骤停85分钟抢救成功一例

患儿女，12岁，于2003年4月12日下午3：50不慎溺水（淡水）20余分钟，被救援人员抢救上岸，立即将患儿头低足高位．口中流出大量液体，神志不清，约10分钟路程送入我院急诊科。查体：脉博0次／min，呼吸0次／min，血压0mmHg，意识丧失，瞳孔散大，对光反射消失，四肢冰凉、发绀．心电监护示一条直线。诊断：重度溺水，呼吸、心跳骤停。立即气管插管，人工、机械呼吸（IPPV），胸外按压，建立静脉通道，反复静推肾上腺素，5min 1次，剂量从1mg逐渐增到3mg，同时静推氨茶碱0．25共2次，阿托品、纳洛酮、地塞米松、碳酸氢钠等，入院1h出现少许室性逸搏，     

小儿麻醉期间心搏骤停复苏成功一例

患儿女 ,16个月 ,7 2kg ,身高 72cm。先心病行室间隔缺损修补、动脉导管结扎和主动脉中断纠治术后 1个月。门诊复查时发现呼吸稍促 ,听诊心音遥远。心脏彩超检查示心脏术后无残余分流及残余梗阻 ,心包内大量积液。急诊收入院 ,行心包积液引流术。术前血常规、生化和电解质检查无异常。术前禁食 6h。入室前 30min口服咪唑安定3 5mg。入室后患儿安静 ,呼吸 4 0次 /min ,HR 15 0次 /min ,Bp 80 / 5 0mmHg ,SpO2 96 % ,予开放右手背外周静脉。麻醉诱导 :阿托品 0 1mg ,咪唑安定 0 5mg ,芬太尼 0 15mg和维库溴铵 0 8mg ,2min后经口插入ID…     

Current and future therapies of pediatric cardiopulmonary arrest

Objective  To review contemporary guidelines and therapies for pediatric cardiac arrest and discuss potential novel therapies. Methods  Key articles and guidelines in the field were reviewed along with recent publications in the fields of neurointensive care and neuroscience germane to cerebral resuscitation. Results  A total of 45 articles were reviewed. The majority of arrests in the pediatric population are asphyxial in origin-which differs importantly from the adult population. The International Consensus on CPR guidelines are discussed, including good quality CPR, chest compressions without interruptions, resuscitation with 100% oxygen and subsequent titration of oxygen to normal oxygen saturations, correct dose of epinephrine, and use of hypothermia in the first 12–24 hours. Novel therapies that showed success in animal studies, such as hypertensive reperfusion, thrombolytics, hemodilution and extracorporeal CPR are also discussed. Conclusion  With only 30% return of spontaneous circulation, 12% survival to hospital discharge and 4% intact neurologic survival, pediatric cardiac arrest remains an area of intense research for therapies to improve its outcomes. In addition to the rapid implementation of basic and advanced life support interventions, new therapies that may have value include mild hypothermia, extracorporeal support, promotion of cerebral blood flow and other more novel therapies targeting oxidative stress, excitotoxicity, neuronal death, and rehabilitation.     

Recognition of the child at risk of cardiopulmonary arrest

Early treatment is a major factor to improve the outcome of children at risk of cardiopulmonary arrest. That's why it is essential to recognize as soon as possible clinical signs that indicate a respiratory and/or circulatory dysfunction. Immediate systematic assessment and re-assessment of oxygenation, ventilation and organ perfusion status is one of the keys in the prevention of cardiorespiratory arrest in children. Health care staff must assure that a child with signs of acute respiratory and/or circulatory dysfunction is under constant surveillance by a person with ability to interpret signs, identify problems and to initiate emergency treatment, if needed. Respiratory assessment must include respiratory rate, signs of mechanical respiratory failure (nasal flaring, respiratory noises, paradoxical breathing, prolonged expiration) as well as skin-mucous colour. Cardiocirculatory failure assessment includes heart rate, blood pressure, peripheral perfusion (capillary refill time and temperature gradient), level of consciousness and urinary output. In a child with impending signs of cardio-respiratory failure, the priority is to warrant adequate ventilation and oxygenation. If, despite this treatment, there is no improvement in perfusion, treatment of circulatory failure with fluids and vasoactive drugs is necessary.     

Iatrogenic cardiopulmonary arrest during pediatric sedation with meperidine, promethazine, and chlorpromazine.

The pediatric sedative combination of meperidine, promethazine, and chlorpromazine (MPC) has been widely used for more than 40 years. Despite its relatively poor efficacy and questionable safety profile, many emergency departments (EDs) continue to stock specially formulated mixtures of these three agents. We report a case of iatrogenic cardiac arrest in a 2-month-old infant in whom a consulting resident administered too much MPC (10 times the expected dose) by the wrong route (intravenous instead of intramuscular). The child was successfully resuscitated with no apparent neurologic deficit. Subsequently, we have removed MPC entirely from our ED and instituted a policy restricting ED procedural sedation privileges to emergency physicians. We urge other EDs to do likewise.     

先天性甲状腺功能减退症误诊致水中毒一例

患儿男,30d,因皮肤黄染27d,咳嗽、纳差2d,于2004年11月3日入院。患儿系孕2产2,孕41．3周,顺产分娩于本院产科,出生体重2900g。配方乳喂养,出生后3d皮肤出现黄染,持续不退;生后进食少,每天进食4～5次,每次20～30ml奶量;时有吐奶,2～3d1次大便,体重增加不理想。近2d来轻咳,伴流涕、痰鸣,纳差。父母体健,其姐3岁,发育正常,无家族遗传疾病史。体检：T36．5℃,R35次／min,P136次／min,体重3065g,反应可,无特殊面容,皮肤黄染,见数粒脓疱疹。咽部充血,双肺呼吸音清,未闻干湿性哕音。