两种不同复苏方式的早期复苏成功率比较

目的:探讨心跳停止4min内,即在大脑发生不可逆转的坏死前开始复苏,开胸与闭胸复苏在自主循环恢复率(ROSC)、心肺脑复苏成功率方面的差异。方法:健康杂种犬24只,随机分为:闭胸复苏组(CCCPR组),开胸复苏组(OCCPR组)。闭胸复苏组采用国际心肺复苏指南2005的标准及体外除颤的方法进行复苏;开胸复苏组,采用开胸直接挤压心脏及心外膜除颤方法进行复苏。按压(或挤压)2min后,静脉注射肾上腺素1mg,继续复苏2min后,电击除颤。如自主循环未恢复,则继续以上复苏,复苏30min无效则放弃。结果:自主循环恢复率:CCCPR组4/12(33.3%),OCCPR组12/12(100%),两组比较差异有统计学意义(P<0.001)。心肺脑复苏成功率:CCCPR组4/12(33.3%),OCCPR组11/12(91.7%),两组比较差异有统计学意义(P<0.001)。自主循环恢复时间:CCCPR组15～30min,平均21min;OCCPR组4～10min,平均8min。结论:对发生在院内及有急救人员在现场的心跳停止者,宜及早采用开胸心肺复苏,以确保大脑复苏成功。     

胸外按压中断时间长短对心肺复苏效果的影响

目的探讨心肺复苏(CPR)过程中,除颤期及气管插管期胸外按压中断时间长短对CPR复苏效果的影响。方法根据2010年CPR指南,规范CPR除颤期及气管插管期流程,缩短CPR过程中胸外按压中断时间。选取2011年1月~2012年12月间82例心脏骤停患者为对照组,实施常规CPR流程。选取2013年1月~2014年12月间80例心脏骤停患者为实验组,实施规范除颤期及气管插管期流程。对两组患者在CPR胸外按压中断时间、自主循环恢复时间、自主循环恢复率进行对比分析。结果两组患者CPR过程中除颤期胸外按压中断时间和气管插管期胸外按压中断时间、自主循环恢复时间比较差异有统计学意义(P<0.05)。结论规范CPR流程,可缩短CPR过程中除颤期及气管插管期胸外按压时间,提高复苏的效果。     

大鼠机械式胸外按压心肺复苏模型的建立

目的 探索用机械式胸外按压复制大鼠心肺复苏（cardiopulmonary resuscitation,CPR）模型的可行方法。方法 成年雄性SD大鼠,随机分为对照组（n=6）与模型组（n=10）。10%水合氯醛腹腔注射麻醉后行气管插管和左侧股动脉插管。在监测心电图与动脉血压条件下,模型组行气管阻塞（tracheal obstruction,TO）,心脏骤停（cardiac arrest,CA）出现2 min用呼吸机辅助和自制动物胸外按压仪行CPR。结果 模型组TO后迅速出现自主呼吸停止,紫绀,心律失常,4～5 min出现心脏停搏,动脉收缩压降至40 mmHg以下,脉压消失,CA出现。2 min后给予CPR,8只大鼠自主循环恢复（return of spontaneous circulation,ROSC）,并出现一过性再灌注心律失常,6只大鼠恢复意识并存活24 h。血液生化分析提示模型组大鼠存在电解质紊乱、酸中毒、肾功能损害、心肌酶谱升高。病理学切片观察发现模型组大鼠心肌横纹溶解,肾小球无复流,神经元减少,肺淤血等器官损害。结论 机械式胸外按压可以提供CA大鼠CPR所需的基本心输出量,可以成功建立大鼠CPR模型。     

In-hospital cardiopulmonary resuscitation

A retrospective review of 399 cardiopulmonary resuscitation (CPR) efforts in 329 veterans was performed to evaluate the observation that few geriatric patients were discharged alive after they underwent CPR. Cardiopulmonary resuscitation efforts with witnessed arrests were more frequently successful than efforts with unwitnessed arrests (47.7% vs 29.9%) and resulted in live discharge more often than efforts with unwitnessed arrests. Cardiopulmonary resuscitation efforts that resulted in a live discharge were more brief and involved a lower mean number of medication doses. Of the 77 CPR efforts in patients 70 years of age or older who had arrests, 24 (31%) were successful, and in 22 (92%), patients were alive after 24 hours. None lived to discharge. There were 322 CPR efforts in the younger cohort; 137 (43%) were successful, in 124 (91%) of these 137 efforts, patients were alive after 24 hours, and in 22 (16%), patients were discharged alive. Older patients were significantly less likely to live to discharge both at the time of arrest and 24 hours after successful resuscitation. When a multivariate analysis was used, the presence of sepsis, cancer, increased age, increased number of medication doses administered, and absence of witness were all "predictive" of poor outcome. Cardiopulmonary resuscitation should be administered only to those who have the greatest potential benefit from this emotionally and physically traumatic procedure.     

护士的心肺复苏术规范化培训对心肺复苏效果的影响

目的:探讨护士的心肺复苏术规范化培训对心肺复苏效果的影响。方法:统计心肺复苏术规范化培训前和培训后的心肺复苏情况,采用卡方检验回顾性分析相关数据。结果:心肺复苏规范化培训前和培训后的心肺复苏成功率分别为65.1%和84.4%,成功率差异有统计学意义(P<0.05)。结论:规范化培训能提高ICU护士心肺复苏的成功率。     

心肺复苏和心肺脑复苏成功病例的对比分析

目的探讨影响心肺脑复苏（CPCR）的相关因素。方法收集单纯心肺复苏（CPR）成功（对照组）和心肺脑复苏（CPCR）成功（观察组）患者的临床资料,分析其基础疾病、心脏骤停原因、心脏骤停持续时间和脑缺血缺氧时间对CPCR的影响。结果两组患者基础疾病的分布不同;与对照组相比,观察组心脏骤停持续时间、自主心跳恢复时间和脑缺血缺氧时间较短（P〈0.01）。结论基础疾病和心脏骤停持续时间与心肺脑复苏成功有关。     

Traumatic pneumobilia after cardiopulmonary resuscitation

Pneumobilia is a rare pathological finding, which denotes an abnormal connection between the gastrointestinal and the biliary tract. In the absence of surgically created anastomosis between the bowel and the bile duct, the most common causes for pneumobilia are gallstone obstruction, endoscopic interventions, or emphysematous cholecystitis. We present this case of a middle-aged multiple-injured male who developed traumatic pneumobilia after cardiopulmonary resuscitation. We suppose that chest compression in combination with a sphincter of Oddi (SO) dysfunction forced intraluminal air retrograde through the SO into the biliary tract, since intraabdominal injury as well as former biliary pathology, inflammation, or biliary-enteric fistula were excluded.     

心肺复苏的应用进展

本文旨在对心肺复苏的发展史、生命支持及心肺复苏的方法与应用的药物进行综述如下,旨在提高对心肺复苏的进一步了解.     

Tension pneumoperitoneum after cardiopulmonary resuscitation

OBJECTIVE: To increase awareness of the unusual complication of pneumoperitoneum after cardiopulmonary resuscitation. CLINICAL FEATURES: A 57-year-old male farmer with a history of chronic renal failure and heart disease, as well as severe oesophageal reflux for which fundoplication had been performed, developed a tension pneumoperitoneum after cardiopulmonary resuscitation. This resulted in lower limb cyanosis and an erection, a previously unreported complication. INTERVENTION AND OUTCOME: The tension was relieved by uncapping a peritoneal dialysis catheter that was in situ. The cyanosis and erection resolved immediately, suggesting that the tension pneumoperitoneum had caused significant venous obstruction. A 3 cm defect in the posterior wall of the stomach was repaired. CONCLUSION: The likelihood of pneumoperitoneum is reduced if standard guidelines for cardiopulmonary resuscitation are adhered to.     

心肺复苏的新观念

目的：探讨心肺复苏术（ＣＰＲ）成功的因素;方法：在心肺复苏时,改变传统ＣＰＲ的顺序,采用主动按压－减压心肺复苏术,使用大剂量肾上腺素;结果：心肺复苏的成功率增加;结论,主动按压－减压心肺复苏术及大剂量肾上腺素可以提高复苏成功率。     

Artificial ventilation for cardiopulmonary resuscitation

The ability of 100 members of the nursing staff to administer artificial ventilation was tested on a manikin. Six techniques of artificial ventilation were used. A minimum minute volume of 6 L was chosen as the criterion for adequate ventilation. Eighty-eight per cent of nurses "passed" using mouth-to-mouth ventilation, 66% "passed" using mouth-to-face-mask, 55% "passed" using the RM-1 injector system, 52% "passed" using the Mistviva injector system, while very low "pass" rates of 25% and 15% were obtained with the Air-Viva and Mapleson B circuits, respectively. It was concluded that mouth-to-mouth technique was the best form of ventilatory support provided by the nursing staff tested in this trial. In general, the use of mask systems should be restricted to highly trained staff members who have demonstrated continuing proficiency.     

Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial

Context  High-quality cardiopulmonary resuscitation (CPR) may improve both cardiac and brain resuscitation following cardiac arrest. Compared with manual chest compression, an automated load-distributing band (LDB) chest compression device produces greater blood flow to vital organs and may improve resuscitation outcomes. Objective  To compare resuscitation outcomes following out-of-hospital cardiac arrest when an automated LDB-CPR device was added to standard emergency medical services (EMS) care with manual CPR. Design, Setting, and Patients  Multicenter, randomized trial of patients experiencing out-of-hospital cardiac arrest in the United States and Canada. The a priori primary population was patients with cardiac arrest that was presumed to be of cardiac origin and that had occurred prior to the arrival of EMS personnel. Initial study enrollment varied by site, ranging from late July to mid November 2004; all sites halted study enrollment on March 31, 2005. Intervention  Standard EMS care for cardiac arrest with an LDB-CPR device (n = 554) or manual CPR (n = 517). Main Outcome Measures  The primary end point was survival to 4 hours after the 911 call. Secondary end points were survival to hospital discharge and neurological status among survivors. Results  Following the first planned interim monitoring conducted by an independent data and safety monitoring board, study enrollment was terminated. No difference existed in the primary end point of survival to 4 hours between the manual CPR group and the LDB-CPR group overall (N = 1071; 29.5% vs 28.5%; P = .74) or among the primary study population (n = 767; 24.7% vs 26.4%, respectively; P = .62). However, among the primary population, survival to hospital discharge was 9.9% in the manual CPR group and 5.8% in the LDB-CPR group (P = .06, adjusted for covariates and clustering). A cerebral performance category of 1 or 2 at hospital discharge was recorded in 7.5% of patients in the manual CPR group and in 3.1% of the LDB-CPR group (P = .006). Conclusions  Use of an automated LDB-CPR device as implemented in this study was associated with worse neurological outcomes and a trend toward worse survival than manual CPR. Device design or implementation strategies require further evaluation. Trial Registration  clinicaltrials.gov Identifier: NCT00120965      

在中国实施院前心肺复苏需要人工通气

心肺复苏（CPR）是针对心脏骤停的一系列救援措施用以挽救患者生命。及早有效的院前CPR是挽救患者生命的重要措施。近年来国际CPR的指南有较大改变,更重视通过胸外按压环节以维持循环,弱化了人工通气环节。单纯胸外按压而不需要人工通气的基础CPR广为流传。本文综述近现代CPR的发展及相关研究结果。考虑无氧6 min可导致脑损伤、在中国救护车到达现场和转运时间较长、单纯胸外按压容易疲劳等情况,我们认为在中国实施单纯胸外按压的CPR并不合适。一些非专业人员虽然感到口对口人工通气比较难实施,但是大部分还是愿意施行人工通气操作的。广泛开展公众CPR培训,提高对包括人工通气和胸外按压环节的CPR认知度和掌握度,以维持有效通气和循环是目前中国CPR发展的重点。