急诊医生实施气管插管术对心肺复苏预后的影响

心搏呼吸骤停抢救的成功受多种因素影响,有效的心肺复苏术(CPR)是保证,其中通气是关键。及早行气管插管对提高复苏成功率和生存率,减少复苏后神经后遗症有重要意义。我们对120例心搏呼吸骤停患者由急诊医生在第一时间实施紧急气管插管,配合心脏按压、除颤等复苏措施,临床效果好,现报道如下。一、对象与方法1.研究对象:选择2001年2月~2006年1月我院急诊科院前急救心搏呼吸骤停患者120例,其中男75例,女45例,年龄8~76岁,平均年龄(50.6±16.5)岁。心搏呼吸骤停原因:急性心肌梗死35例,严重创伤52例,脑血管意外13例,电击伤3例,自缢2例,溺水3例,…     

老年人脑复苏的研究探讨

正老年患者在发生心搏呼吸骤停后,如能及时正确的处理,基本生命体征可望在短期内恢复稳定。Simon等[1]报道,25%~50%心搏骤停患者经标准心肺复苏(CPR)能够恢复自主循环,但治愈率仍在2%~14%的低水平,造成这一差异的原因主要是顽固性神经细胞损伤,CPR成功后,自主循环重新恢复,复杂的继发性脑血流分布紊乱导致了脑再灌注损伤和易损神经元的死亡,且伴有大脑功能预后的进一步恶化[2]。脑复苏的最终目的是恢复中枢神经功能,恢复患者智能及生活自理能力。     

老年人脑复苏的研究探讨

<正>老年患者在发生心搏呼吸骤停后,如能及时正确的处理,基本生命体征可望在短期内恢复稳定。Simon等[1]报道,25%~50%心搏骤停患者经标准心肺复苏(CPR)能够恢复自主循环,但治愈率仍在2%~14%的低水平,造成这一差异的原因主要是顽固性神经细胞损伤,CPR成功后,自主循环重新恢复,复杂的继发性脑血流分布紊乱导致了脑再灌注损伤和易损神经元的死亡,且伴有大脑功能预后的进一步恶化[2]。脑复苏的最终目的是恢复中枢神经功能,恢复患者智能及生活自理能力。     

5例心跳骤停与心肺复苏抢救的回顾性分析

目的从高校学生院前心跳呼吸骤停患者的心肺复苏救治经验,探讨加强掌握心肺复苏技能的意义和方法,以及在高校校园普及心肺复苏术(CPR)的必要性和可行性。方法对5例心跳骤停患者施行心肺复苏抢救进行回顾性分析。结果 5例心跳骤停患者中,初步复苏成功1例。结论及时正确高质量的心肺复苏术及密切观察和捕捉心肺复苏显效的征象,可明显激励第一目击者及医护人员的CPR信心,从而提高对呼吸心跳骤停患者实施心肺复苏的有效性。加强和重视高校门诊部医护人员的CPR培训,在大学生中普及CPR知识和技能,提高第一目击者CPR水平,对于初步挽救心跳呼吸骤停患者生命,减少致残率,具有重要意义和作用。     

严重低血钾致心跳呼吸骤停心肺复苏的体会

目的探讨严重低钾血症致心跳呼吸骤停患者心肺复苏的有效方法.方法对我院急诊科近5年来,抢救成功的5例严重低钾血症所致心跳呼吸骤停患者心肺复苏过程进行回顾性分析总结.结果全部患者均在心电监护显示心脏骤停(心室纤颤)发生后即刻(1～2分钟)实施正规心肺复苏,在此基础上给予微量泵或输液泵超常规高浓度补钾,5例复苏成功,其中4例存活,1例死于复苏后MODS.结论在早期正规心肺复苏的基础上,采用超常规、高浓度补钾是救治严重低血钾所致心跳呼吸骤停患者的主要方法,可提高其复苏成功率.     

严重低血钾致心跳呼吸骤停心肺复苏的体会

目的 探讨严重低钾血症致心跳呼吸骤停患者心肺复苏的有效方法。方法 对我院急诊科近5年来，抢救成功的5例严重低钾血症所致心跳呼吸骤停患者心肺复苏过程进行回顾性分析总结。结果 全部患者均在心电监护显示心脏骤停（心室纤颤）发生后即刻（1～2分钟）实施正规心肺复苏，在此基础上给予微量泵或输液泵超常规高浓度补钾，5例复苏成功，其中4例存活，1例死于复苏后MODS。结论 在早期正规心肺复苏的基础上，采用超常规、高浓度补钾是救治严重低血钾所致心跳呼吸骤停患者的主要方法，可提高其复苏成功率。     

急诊医生实施气管插管术对心肺复苏预后的影响

心搏呼吸骤停抢救的成功受多种因素影响，有效的心肺复苏术（CPR）是保证，其中通气是关键。及早行气管插管对提高复苏成功率和生存率，减少复苏后神经后遗症有重要意义。我们对120例心搏呼吸骤停患者由急诊医生在第一时间实施紧急气管插管，配合心脏按压、除颇等复苏措施，临床效果好，现报道如下。     

影响心肺脑复苏因素的Logistic回归分析

目的　分析发生心脏呼吸骤停的原因并找出影响心肺脑复苏成功率的因素。方法　应用Logistic多元回归分析心跳骤停患者心肺复苏及自主循环恢复 (ROSC)后影响存活率的有关因素。结果　单因素分析显示与心肺脑复苏及预后相关的因素有6个 :心搏骤停发生地点、CPR开始的时间、ROSC的间期、瞳孔、复苏后综合征、年龄等。多因素分析仅PRM有统计学意义。结论　在筛出的因素中显示心肺复苏成功关键是复苏开始的时间。复苏后MODS -复苏后综合征 (PRM)是影响心肺复苏自主循环恢复后存活率的独立因素。现场进行快速及有效心肺复苏是抢救成功关键。心肺复苏成功后重点应放在对各脏器功能的评估、支持、监护治疗上。     

紧急气管插管影响心肺复苏预后的探讨

有效的心肺复苏术(CPR)是心搏呼吸骤停抢救的成功保证,而通气是关键.及早行气管插管对提高复苏成功率和生存率,减少复苏后神经后遗症有重要意义.总结100例心脏停搏后紧急气管插管患者,配合心脏按压、除颤等复苏措施,临床效果好,报告如下.     

院内心肺复苏成败影响因素的回顾性分析

目的 :分析影响院内心肺复苏 (CPR)成败的相关因素 ,探讨提高心肺复苏成功率的有效方法。方法 :对2 86例实施院内心肺复苏的心跳呼吸骤停患者进行回顾性分析。结果 :心肺复苏成功率及出院存活率分别为 5 3 .8%和9 .4 % ;心跳呼吸骤停 10min以内的患者经积极有效的CPR、气管插管、电击复律能大大提高复苏成功率差异均有显著性 ,P <0 . 0 1;大剂量肾上腺素的应用虽能提高初期心肺复苏成功率 ,但对后期复苏及提高存活率并无帮助。结论 :及早CPR、及早气管插管、及早电击复律和合理应用肾上腺素是心肺复苏成功的关键。     

围生期心脏骤停孕产妇特点及心肺复苏术预后分析

目的 研究围生期心脏骤停孕产妇的特点和预后情况.方法 选取杭州市余杭区第一人民医院2008年1月至2016年6月收治的围生期心脏骤停孕产妇20例,分析心脏骤停孕产妇的临床资料,包括年龄、性别、孕周、产次及分娩方式,同时录入手术指征、病因及心脏复苏至分娩时间.结果 20例孕产妇中5例采取阴式分娩(20%),13例采取剖宫产(65%),2例采取引产(10%);7例剖腹产手术指征不明确(35%),9例羊水栓塞(45%),5例子痫(20%),3例产科出血(15%).产科首次抢救9例发生心脏骤停的孕产妇,其中存活3例,死亡6例;产科和ICU联合首次抢救11例发生心脏骤停的孕产妇,其中存活10例,死亡1例,不同抢救方式存活率差异有统计学意义(χ2=7.213,P=0.007).7例患者在分娩前发生呼吸心脏骤停,5例死亡,2例存活;13例分娩后发生呼吸心脏骤停,2例死亡,11例存活.13例存活患者中7例伴随严重脑损伤后遗症.结论 孕产妇发生心脏骤停引起死亡率较高,产科联合ICU能有效提高抢救成功率,提高辨识危险因素的准确度可有效降低死亡率.     

Factors associated with successful resuscitation of out-of-hospital cardiac arrest at Rajavithi Hospital's Narenthorn Emergency Medical Service Center, Thailand

The objective of this study is to determine factors associated with successful resuscitation of out-of-hospital cardiac arrest (OHCA) patients by Narenthorn Emergency Medical Service Center (EMS), Thailand. A retrospective observational study was conducted with 73 OHCA patients who were resuscitated from December 2004 to January 2007. Inferential statistics, univariate (χ(2)) and multivariate analyses (logistic regression) were applied for data analysis. A total of 73 OHCA patients were included. The mean age was 58.3 years; 86.3% were ≥40 years, 72.6% were male. The causes of arrest were cardiac problem 53.4%. In all, 46.6% were witnessed arrest; 53.4% had response time (RT) ≥10 minutes, and 27.4% had bystander cardiopulmonary resuscitation (CPR). Overall, 79.5% were found in the residence. Initial electrocardiogram showed that 74% were nonshockable rhythm. A total of 34.2% were resuscitated by an EMS team with <4 members, and 53.4% had return of spontaneous circulation, survival to admission was 61.5% and survival to discharge was 7.7%. Witnessed arrest (odds ratio [OR] = 7.403; 95% confidence interval [CI] = 2.169-24.683) and bystander CPR (OR = 5.619; 95% CI = 1.014-36.170) had correlation with successful resuscitation of OHCA patients. RT showed a trend toward statistical significance (OR = 1.051; 95% CI = 0.765-16.083). This study found that witnessed arrest and bystander CPR were major factors associated with successful resuscitation of OHCA patients. Our findings will be useful for the development of community programs to decrease the mortality from OHCA.     

Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation.

As part of an evaluation of whether the addition of paramedic services can reduce mortality from out-of-hospital cardiac arrest compared to previously existing emergency medical technician (EMT) services, factors associated with successful resuscitation were studied. A surveillance system was established to identify cardiac arrest patients receiving emergency care and to collect pertinent information associated with the resuscitation. Outcomes (death, admission, and discharge) were compared in two areas with different types of prehospital emergency care (basic emergency medical technician services vs. paramedic services). During the period April 1976 through August 1977, 604 patients with out-of-hospital cardiac arrest received emergency resuscitation. Eighty-one per cent of these episodes were attributed to primary heart disease. Considered separately, four factors were found to have a significant association with higher admission and discharge rates :1) paramedic service, 2) rapid time to initiation of cardiopulmonary resuscitation (CPR), 3) rapid time to definitive care, and 4) bystander-initiated CPR. Using multivariate analysis, rapid time to initiation of CPA and rapid time to definitive care were most predictive of admission and discharge. Age was also weakly predictive of discharge. These findings suggest that if reduction in mortality is to be maximized, cardiac arrest patients must have CPR initiated within four minutes and definitive care provided within ten minutes.     

心肺复苏仪在突发心跳呼吸骤停患者中的应用探究

目的:探讨心肺复苏仪在突发心跳呼吸骤停患者中的应用.方法:选取2016年1月~2018年12月本院急诊科突发心跳呼吸骤停140名患者为观察对象,按数字表法随机分为徒手CPR组和CPR仪组,每组各70人,监测两组患者自主循环恢复(ROSC)率以及CPR后10min、30min的MAP、颈总动脉血流速度.结果:两组间MAP、颈总动脉血流速度在CPR开始后10min、30min比较差异有统计学意义,CPR仪组优于徒手CPR组(P<0.05).比较两组ROSC率比较差异有统计学意义,徒手CPR组ROSC成功率为22.86%,CPR仪组ROSC成功率48.57%,CPR仪组优于徒手CPR组(P<0.05).结论:与徒手心肺复苏比较,使用心肺复苏仪可以提高ROSC成功率,同时改善心、脑等重要器官供血,减少重要器官组织缺血性损伤,有利于患者预后.     

126例猝死患者现场急救情况临床分析

目的探讨分析126例猝死患者的现场急救措施及经过,总结抢救经验,改进不足,提高现场复苏成功率。方法回顾性分析5年来我区急救中心出诊抢救的126例猝死患者的临床资料。结果126例患者中11例复苏有效(8.73%);115例复苏失败(91.3%);其中11例家属放弃抢救(8.73%);104例抢救无效最后死亡(82.5%)。11例复苏成功的患者均在第一时间被发现并及时呼救或现场即有目击者行徒手CPR术。结论猝死病人的现场抢救十分重要,包括早期识别和呼救、早期CPR、早期除颤、早期高级生命支持的“四早”,是猝死病人的“生存链”,环环相扣。     

PICU心搏骤停患儿心肺复苏失败的相关因素分析

目的 探讨影响儿科重症监护病房(PICU)心搏骤停患儿心肺复苏失败的相关因素.方法 随机选取2013年1月至2016年12月在温州市中心医院儿科重症监护病房住院的心搏骤停患儿90例,对其:①系统相关因素;②心搏骤停出现前的相关因素;③CPR期间的相关因素进行观察,并对相关因素进行分析.结果 全组中有28例(31.11%)心肺复苏失败患儿.入住儿科重症监护病房时间(χ2=5.15)、心搏骤停前有无给予镇静药物(χ2=15.56)、有无进行中心静脉通路(χ2=3.02)、心肺复苏时间(χ2=21.13)、心肺复苏操作时有无进行胸外按压(χ2=4.06)、有无进行正压通气(χ2=8.05)、有无气管插管(χ2=5.03)及补碱(χ2=10.42)因素下,其患儿心肺复苏失败率均存在明显差异(均P<0.05);而心搏骤停出现时间、心搏骤停出现前有无进行机械通气、有无给予镇痛或血管活性药物、有无补钙、有无给予抗心律失常药物及心肺复苏时有无给予肾上腺素因素下,其患儿心肺复苏失败率均无明显差异(均P>0.05);经多因素Logistic回归分析结果表明,心搏骤停前给予镇静药物(OR=12.24)、心肺复苏时间(OR=0.02)、心肺复苏操作时进行胸外按压(OR=0.07)、正压通气(OR=312.05)、补碱(OR=0.02)与心肺复苏失败存在相关关系(均P<0.05).结论 心肺复苏时间超过30min、心肺复苏操作时进行胸外按压及补碱的心搏骤停患儿出现心肺复苏失败率较高.因此,患儿出现心搏骤停前应给予其镇静药物并在心肺复苏期间应进行正压通气,有助于减少心肺复苏失败率.     

Cardiac arrests in skilled nursing facilities: continuing room for improvement?

OBJECTIVES: To characterize the care received by skilled nursing facility (SNF/NF) patients suffering cardiac arrest and to evaluate the outcome of SNF/NF patients experiencing cardiac arrest. DESIGN: A retrospective analysis of an existing cardiac arrest registry to characterize SNF/NF cardiac arrest patients and to compare them to community-dwelling cardiac arrest patients was performed. SETTING: The study took place in Rochester, NY, an urban city in upstate New York with approximately 220,000 residents. PARTICIPANTS: All patients for whom emergency medical services (EMS) assistance was requested via the 911 system and who were treated for cardiac arrest between January 1998 and December 2001 were included. MEASUREMENTS: Demographic characteristics such as age, gender, race; clinical characteristics and interventions such as cardiopulmonary resuscitation (CPR), defibrillation, initial cardiac rhythm, and call response interval; outcomes measures such as return of spontaneous circulation and 1-year survival were obtained. RESULTS: Forty-two (8%) of cardiac arrest patients resided in an SNF/NF. Sixteen (38%) of the events were witnessed arrests. Only 28 (67%) patients received CPR and none were defibrillated prior to EMS arrival. One (2%) patient was alive 1 year after the event, a survival rate similar to the community-dwelling population (5%). CONCLUSION: SNF/NF patients suffering cardiac arrest often did not receive CPR or defibrillation while awaiting EMS arrival. SNF/NF patients suffering cardiac arrest have a very low survival rate, similar to the community-dwelling population. The impact of not providing CPR and defibrillation on the survival rate is unclear, but needs to be evaluated prior to any decisions regarding the medical futility of resuscitating SNF/NF patients.     

Preparedness for Cardiac Emergencies Among Cambodians with Limited English Proficiency

In the United Sates, populations with limited English proficiency (LEP) report barriers to seeking emergency care and experience significant health disparities, including being less likely to survive cardiac arrest than whites. Rapid utilization of 9-1-1 to access emergency services and early bystander cardiopulmonary resuscitation (CPR) is crucial for successful resuscitation of out-of-hospital cardiac arrest patients. Little is understood about Asian LEP communities’ preparedness for emergencies. In this exploratory survey, we sought to assess intentions to call 9-1-1 in an emergency and knowledge of CPR in the Cambodian LEP community. We conducted an in-person interview with 667 Cambodian adults to assess their intentions to call 9-1-1 and their awareness of and training in bystander CPR. While the majority of participants stated that they would call 9-1-1 in an emergency, almost one-third of the sample would call a friend or family member. Awareness of CPR was very high but training in CPR was lower, especially for women. A higher level of English proficiency and greater proportion of time in the US was a strong predictor of CPR training and intention to call 9-1-1 in an emergency. This suggests that greater efforts need to be made to reach the most linguistically-isolated communities (those with little or no English) with emergency information in Khmer.     

心肺复苏成功后45例患者的护理策略

目的探讨心脏骤停心肺复苏术(CPR)初步成功后患者的护理措施,制定严密完善的护理策略。方法收集作者医院近5年来CPR成功后,病情允许转送中心重症监护室(ICU)进一步治疗者45例的临床资料、护理要领和心得。结果本组45例,经良好的循环功能、呼吸功能、脑功能的支持、维持,均于入急诊抢救室后6 h内转入中心ICU,进行进一步的生命支持和康复治疗。结论医护的密切配合、严密的护理策略预案、高质量的护理技术、敏锐的观察力和迅速高效的反应机制是提高CPR成功的不可或缺的重要环节。