心脏停搏心肺脑复苏后的康复对策

目的探讨CA心肺脑复苏后的康复对策。方法分析我科17例CA患者心肺脑复苏后所实施的康复治疗措施。结果生存1年以上者8例，其中1例生存16年。康复的具体有效措施实施直接影响患者的预后。结论维持循环稳定、支持呼吸等综合性心脏康复方案是CA心肺脑复苏成功与否的重要因素。     

低通气在成人心肺复苏中的救治效果分析

目的比较低通气及常规通气对复苏成功率及动脉血气结果的影响,指导复苏通气参数的选择。方法收集我科2005—2010年成年心肺复苏患者138例,复苏过程中采用PB 760呼吸机行容量控制通气（VCV）,按参数设置不同分常规通气组71例,低通气组67例,比较两组间PaO2、PaCO2、PIP及复苏成功率差异。结果两组间PaO2、PaCO2无统计学意义（P〉0.05）,低通气组PIP明显低于常规通气组（P〈0.05）,低通气组复苏成功率明显高于常规通气组,两组间差异有统计学意义（P〈0.05）。结论心肺复苏机械通气中应采用低通气方式。     

亚低温治疗在心肺复苏中应用研究进展

对于心搏骤停患者，心肺复苏是主要的急救措施。如何提高心肺脑复苏的救治成功率，提高复苏成功者的生活质量一直是医学界的研究热点。近年来国内外学者在心肺复苏方面做了大量的研究，其中亚低温治疗被认为是极其有效的脑复苏方法之一。亚低温治疗采用物理降温使病人体温处于一种可控性的低温状态，从而达到使中枢神经系统处于抑制状态，对外界及各种病理性刺激的反应减弱，对机体具有保护作用。本文就近年来亚低温疗法在心肺复苏的研究进展综述如下。     

心肺脑复苏23例体会

目的：观察不同程序复苏时心脏骤停或伴呼吸停止的抢救成功率。方法：对14例单纯心脏骤停，按心脏按压，药物、电复苏技术进行心脏复苏；9例伴呼吸停止，按常规呼吸、心脏、药物、电技术程序进行复苏，所有病例均行脑复苏。结果：23例心肺复苏成功2l例(91．30％)，心肺脑复苏成功16例(69．57％)。结论：根据是否呼吸停止决定复苏程序有望提高复苏成功率，早期进行脑复苏是心肺脑复苏成功的关键。     

不同通气方法对心肺脑复苏患者的影响

目的:比较不同通气方法在心肺脑复苏(CPCR)中的临床应用效果。方法:,回顾性分析抢救的87例心跳骤停患者的临床资料,根据所用通气方法的不同分为3组:一次插管组、气囊面罩组和多次插管组。比较3组患者的心脏复苏(CR)成功率、心肺复苏(CPR)成功率、CPCR成功率以及复苏后多器官功能障碍综合征(PR-MODS)的发生率。结果:与一次插管组比较,气囊面罩组的复苏成功率及PR-MODS的发生率无显著差异(P>0.05),而多次插管组则显示复苏成功率明显降低,PR-MODS的发生率明显升高(P<0.05)。结论:CPCR抢救中,紧急气管插管失败后,气囊面罩加压给氧可作为过渡时期简单有效的通气方法。     

老年患者急救气管插管76例临床回顾性分析

气管插管可在最短时间内建立人工气道,保障氧疗,且有助于防止误吸,有利于气道异物吸引和使用多种通气方式及气管内给药,可提高危重病患者抢救成功率及心肺复苏术后患者的生活质量。给病人进行紧急有效的供氧是提高心肺脑复苏成功率的关键措施,因而紧急气管插管术在各种急重症的     

高龄患者急性心肺复苏的临床体会

笔者对 8 5 2例院内急性心脏搏停的患者 ,以回顾性、对照性的研究方式 ,分析评价老年心脏搏停患者的临床特点、急性心肺脑复苏期间的治疗措施及心肺脑复苏后 6h、12h、2 4h时的意识状态评分与复苏后患者近期生存率及生存时间之间的关系 ,找出复苏后患者的高危人群 ,有效地更有针对性地做好高龄患者的心肺脑复苏 ,增加复苏成功率、改善预后。1　资料和方法1 1　病例选择　 1998～ 2 0 0 2年间在本院急诊就诊期间发生的急性心肺骤停的患者 ,年龄 15～ 90岁 ,所有患者均行标准CPR ,且复苏后患者的后续生命支持皆相近似 ,如 2 4h内心电、血压…     

脑复苏的研究进展

心肺复苏的最终成功是复苏后大脑功能的恢复。随着心肺复苏技术的进步和新药物的使用，自主循环和呼吸复苏的成功率有了很大提高，但心肺脑的复苏成功率仍低于20%。即使复苏成功存活者，相当一部分人是带病生活，严重影响日常生活质量，给社会和家庭带来沉重的负担。如何提高心肺脑复苏的成功率，提高复苏成功患者的生活质量一直是急救医学和重症医学研究的方向。近年来国内外学者在脑保护脑复苏方面做了大量的工作，本文就脑保护与脑复苏治疗方面的一些进展进行综述。     

心肺复苏应用临时心脏起搏治疗的临床意义

目的 研究心肺复苏（CPR）应用临时心脏起搏治疗对心肺复苏成功率及临床效果的影响。方法 采用回顾性分析。结果 心肺复苏成功32例，失败4例，成功率为88.89%，P＜0.01。结论 证明心肺复苏应用临时心脏起搏治疗可以提高心肺复苏成功率及减少心脏猝死的死亡率，具有重要临床价值。     

脑复苏的亚低温治疗研究进展

心肺复苏(CPR)成功后脑功能恢复是持续生命支持的核心,研究显示亚低温治疗可改善心肺复苏后患者的脑功能,是一种非常有前景的治疗措施。本文就心脏骤停后脑损伤机制、亚低温治疗脑保护机制及治疗策略、常用降温技术、温控监测研究进展做一综述。     

强化液体管理对重症肺炎机械通气的影响

目的 探讨液体管理对重症肺炎机械通气影响.方法 157例重症肺炎分为液体管理组和对照组,脉搏指示连续心输出量监测(PiCCO)指导液体管理,测定肺组织局部IL-6、胸部SCT检查及血浆脑型利钠肽(BNP)了解心肺情况,统计机械通气时间及参数变化.结果 两组相比,液体管理组机械通气时间缩短(P<0.05 ),呼吸机支持力度下降(P<0.05 ),IL-6、BNP均降低(P<0.05),胸部CT病变好转,心肺功能改善.结论 强化液体管理可早脱机、减小呼吸机支持,与改善心肺功能有关.     

Role of respiratory function in exercise limitation in chronic heart failure

OBJECTIVE: To test the hypothesis that respiratory function contributes to limit maximal exercise performance in patients with chronic heart failure by using the technique of dead space loading during exercise. DESIGN: Blinded subjects underwent two maximal incremental exercise tests in random order on an upright bicycle ergometer: one with and one without added dead space. SETTING:: Tertiary-care university teaching hospital. SUBJECTS: Seven patients with stable chronic heart failure (mean +/- SEM left ventricular ejection fraction, 27 +/- 3%). RESULTS: Subjects were able to significantly increase their peak minute ventilation during exercise with added dead space when compared with control exercise (57.4 +/- 5.9 vs 50.0 +/- 5.6 L/min; p < 0.05). Peak oxygen uptake, workload, heart rate, and exercise duration were not significantly different between the added dead space and control tests. Breathing pattern was significantly deeper and slower at matched levels of ventilation during exercise with added dead space. CONCLUSION: Because patients with chronic heart failure had significant ventilatory reserve at the end of exercise and were able to further increase their maximal minute ventilation, we conclude that respiratory function does not contribute to limitation of exercise in patients with chronic heart failure.     

无创双水平正压通气治疗急性左心衰竭15例疗效观察

目的 对经鼻面罩双水平正压通气在急性心源性肺水肿的临床疗效进行观察。方法15例均为危重急性左心衰竭发作，在常规治疗基础上，加用无创机械通气治疗，观察病情好转率。结果 应用无创机械通气治疗的患者，病情好转11例(70％)，2例死亡，气管插管2例。结论 经鼻面罩双水平正压通气治疗重度急性左心衰竭疗效显著。     

曲美他嗪对慢性肺源性心脏病患者心肺功能及生命质量的影响

目的探讨曲美他嗪对慢性肺源性心脏病(肺心病)患者心肺功能及生命质量(QOL)的影响。方法连续选取2010年9月—2012年3月在武汉市武昌医院呼吸内科住院治疗的慢性肺心病患者96例,将其按随机数字表法分为观察组46例和对照组50例。对照组予以常规治疗,观察组在此基础上加用曲美他嗪,12周为1个疗程。观察两组患者治疗前后第一秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、最大呼气中段流速(MMEF)、血浆氨基末端脑钠肽前体(NT-proBNP)水平及QOL评分。结果治疗后观察组患者FEV1/FVC和MMEF高于对照组,NT-proBNP及QOL评分低于对照组(P0.01)。结论曲美他嗪能改善慢性肺心病患者心肺功能,提高其QOL。     

Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure.

Minute ventilation, respiratory rate, and metabolic gas exchange were measured continuously during maximal symptom limited treadmill exercise in 30 patients with stable chronic heart failure. The ventilatory response to exercise was assessed by calculation of the slope of the relation between minute ventilation and rate of carbon dioxide production. There was a close correlation between the severity of heart failure, determined as the maximal rate of oxygen consumption, and the ventilatory response to exercise. Reanalysis of the data after correction for ventilation of anatomical dead space did not significantly weaken the correlation but reduced the slope of the relation by approximately one third. These results show that the increased ventilatory response to exercise in patients with chronic heart failure is largely caused by mechanisms other than increased ventilation of anatomical dead space. This finding supports the concept that a significant pulmonary ventilation/perfusion mismatch develops in patients with chronic heart failure and suggests that the magnitude of this abnormality is directly related to the severity of chronic heart failure.     

Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure

Minute ventilation, respiratory rate, and metabolic gas exchange were measured continuously during maximal symptom limited treadmill exercise in 30 patients with stable chronic heart failure. The ventilatory response to exercise was assessed by calculation of the slope of the relation between minute ventilation and rate of carbon dioxide production. There was a close correlation between the severity of heart failure, determined as the maximal rate of oxygen consumption, and the ventilatory response to exercise. Reanalysis of the data after correction for ventilation of anatomical dead space did not significantly weaken the correlation but reduced the slope of the relation by approximately one third. These results show that the increased ventilatory response to exercise in patients with chronic heart failure is largely caused by mechanisms other than increased ventilation of anatomical dead space. This finding supports the concept that a significant pulmonary ventilation/perfusion mismatch develops in patients with chronic heart failure and suggests that the magnitude of this abnormality is directly related to the severity of chronic heart failure.     

ICU肺部感染者应用无创机械通气的效果

摘要 目的 探讨无创机械通气在治疗ICU肺部感染患者的临床疗效。方法 分析80例重症肺炎患者的临床资料，根据呼吸支持技术分为无创机械通气组（NIPPV组）和有创机械通气组（IV组）各40例,比较两组的心率、血压、血气分析指标以及机械通气时间、ICU住院时间以及生存率。结果　经治疗两组患者的心率、血压、血气分析指标均有明显改善，但治疗后两组差异无统计学意义（P>0.05）；NIPPV组的呼吸机辅助呼吸的时间、ICU住院时间均少于IV组，差异有统计学意义（P<0.05），同时NIPPV组的生存率为72.5%，高于IV组的60%，差异同样具有统计学意义（P<0.05）。结论　采用无创机械通气治疗ICU肺部感染患者可获得与有创通气相似的效果，同时可以减少气管插管率，缩短机械通气时间，提高总体生存率。     

Cardiopulmonary interaction in heart failure

In heart failure lung dysfunction is frequent and is greater the greater the heart failure severity. It can be evaluated in terms of lung mechanics and gas diffusion. Indeed heart-lung interaction is related to heart dimensions and lung fluid content; furthermore heart-lung interaction is influenced by the body position. Lung diffusion is also altered in patients with chronic heart failure, and a low gas diffusion is associated with a reduced performance. During exercise, heart-lung interaction becomes more evident. Heart failure patients show an abnormal hyperventilation due to a progressively increased respiratory rate, and a lower tidal volume; hyperventilation is due to different causes including enhanced responses from chemo- and metabolo-receptors, increased CO(2) production and increased dead space ventilation. Several drugs affect the ventilatory pattern in heart failure patients: ACE-inhibitors and anti-aldosteronic drugs improve lung diffusion and ventilatory efficiency during exercise; beta-blockers reduce exercise-induced hyperventilation. Furthermore, ultrafiltration improves lung mechanics, both at rest and during exercise, through body fluid content reduction.     

机械通气在抢救急性肺水肿时的临床疗效

目的:探讨机械通气在抢救急性肺水肿时的方法和临床疗效。方法:通过分析我院20例急性肺水肿患者机械通气前后体征(血压、心率、呼吸频率)、血气分析(pH、PaO2、SaO2、PaCO2、HCO3-)、X线胸片的变化,并参考相关文献总结机械通气治疗急性肺水肿的方法和效果。有效的机械通气方法包括:高频通气和呼气末正压通气(PEEP)。结果:急性肺水肿并发呼吸衰竭患者机械通气之后1、12h较通气之前的平均血压有所下降,[分别为123.0/74.0、118.0/67.0、129.0/75.5mmHg(1mmHg=0.133kPa),通气后12h与通气前比较,P<0.05]平均心率减慢(分别为98、89、105次/min,通气后12h与通气前比较,P<0.05),平均呼吸频率减慢(分别为22.0、21.0、27.4次/min,均P<0.05),平均SaO2显著改善(分别为91.2%、95.1%、76.2%,均P<0.01)。患者机械通气之后较通气之前PaO2明显增高(从48.8mmHg增加至85.1mmHg),具有统计学意义(P<0.05),其他动脉血气分析指标无明显变化。治疗前后X线胸片提示肺水肿明显改善。结论:正压机械通气是治疗各种原因(包括冠心病急性心肌梗死)引起急性严重左心功能不全的重要辅助措施,严格掌握适应证、密切观察病情、选择合适的通气方法、设置合适的参数,可在短期内使急性肺水肿患者病情改善。     

Presence of cytokeratins in exhaled breath condensate of mechanical ventilated patients

Exhaled breath condensate (EBC) contains small amounts of protein leaving the lung by aerosol droplet generation. Protein patterns in EBC might be useful in monitoring acute and severe pulmonary disease and in particular monitoring of mechanical stress during ventilation. EBC (10ml) was collected from 30 ventilated patients with respiratory failure including 24 patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) and from 10 healthy volunteers. Samples were analyzed using gel electrophoresis. Bands were characterized by matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF). In the EBC of mechanically ventilated patients 53.3% exhibited three bands (50-70kDa), 26.7% two bands, 10% one band, and 10% had no bands. While no bands were detected in volunteers EBC. MALDI-TOF analysis identified these bands as cytokeratins 2, 9 and 10. Cytokeratins 2 and 10 were confirmed by Western blot. The detection rate of cytokeratins was correlated to peak inspiratory pressure, positive endexpiratory pressure and ARDS score, but not with inflammatory markers or smoking status. Cytokeratins are present in EBC of mechanically ventilated patients. A strong correlation with parameters of ventilatory stress, such as increased distension, presence of lung injury and time of ventilation suggests a relation with ventilator-associated damage to the pulmonary parenchyma.