心肺复苏实时反馈系统对心肺复苏培训的效果分析

近年,临床中心脏骤停发生率逐渐升高,对患者生命造成严重威胁。相关统计报道,我国院外死于心脏骤停者达到54.4万例,且生存率极低,仅为1%左右,较美国(3.4%~10%)低[1]。相关指南强调了心肺复苏(CPR)技能的重要性;但在临床考核中显示,目前实践中心的CPR并未满足指南要求[2]。本研究分析CPR实时反馈系统应用于CPR培训中对培训效果的影响,报道如下。     

两种心肺复苏操作技术疗效对比分析

目的:探讨两种心肺复苏(CPR)操作技术的有效性。方法:对16例次心脏骤停患者采取2010年美国心脏病协会CPR和心血管病急症救治指南(新指南)操作技术进行抢救为研究组,回顾性分析心脏骤停实施2005年美国CPR救治指南(旧指南)操作技术抢救21例次患者为对照组,进行对比分析研究。结果:研究组16例次自主循环恢复时间3～15min,平均(6.2±3.3)min。对照组21例自主循环恢复时间4～16min,平均(10.5±6.7)min。研究组抢救16例次成功7例次,成功率43.75%,对照组抢救21例次,成功6例次,成功率28.57%。差异有显著性(P<0.05)。结论:心脏骤停后迅速有效的心脏按压是提高CPR成功的关键,新指南CPR程序C-A-B-D较A-B-C-D更加有效。     

尿激酶对心肺复苏成功率的影响

目的 观察尿激酶对心脏骤停患者的治疗效果,评价其在心肺复苏(CPR)中的临床价值.方法 59例心脏骤停患者根据有无使用溶栓药物分成溶栓组(n=26)和对照组(n=33).对照组患者仅进行标准CPR,溶栓组除了进行标准CPR外,还在复苏初期静脉输注尿激酶150万U.观察2组患者CPR成功率、存活率、并发症发生率.结果 溶栓组CPR成功率高于对照组(65.38% vs. 39.39%, P＜0.05),2组间存活率、并发症发生率差异均无显著性(P＞0.05).结论 尿激酶能提高心脏骤停患者CPR成功率,但不能提高出院存活率.     

院内心脏骤停期间心肺复苏的质量

背景:很多资料均证明,有效的心肺复苏(CPR)可获得良好的生存状况。但在心脏骤停期,关于真正的CPR质量却很少有客观资料。最近的研究对于CPR均是根据公认的国际指南而实施的理念提出了挑战。目的:评估院内CPR质量的多项参数,并确定其对已出版的美国心脏学会指南和国际指南的依从程度。设计和地点:2002年12月11日至2004年4月5日间,67例在芝加哥大学医院发生院内心脏骤停患者的前瞻性观察研究。使用具有新的附加传感功能的监视器/除颤器,记录包括胸部按压比率、按压深度、通气比率、无胸部按压的心脏骤停时间(无血流时间)等CPR质量参数。…     

心脏骤停123例复苏成败的原因分析

目的:探讨心脏骤停及心肺复苏(carclio-pulmonary resuscitation,CPR)成败的原因,分析心脏骤停环境、时间、救护措施与复苏成败的关系,以进一步提高CPR的成功率.方法:对123例心脏骤停患者的临床资料,进行回顾性研究.结果:院内、外两组复苏成功率有极显著性差异(P＜0.01);心脏骤停6 min内与6 min后的CPR结果有极显著性差异(P＜0.005);先由目击者进行CPR和等待医生到场才行CPR的两组差别有统计学意义;不同的CPR措施与复苏成败关系密切.结论:要提高心脏骤停复苏成功率的关键是:①及时、准确地救护;②尽早气管插管、电除颤和脑复苏;③加强复苏知识的普及教育,呼吁社会公众的普遍参与.     

144例心脏骤停患者院内心肺复苏的影响因素分析

目的探讨影响心脏骤停患者院内心肺复苏(CPR)效果的相关因素。方法回顾性分析144例心脏骤停并接受院内CPR患者的资料,根据CPR结果分为有效组(84例)与无效组(60例)。对比分析两组患者的基本情况(年龄、性别、基础疾病等)及CPR情况等临床资料。结果有效组60岁及以上患者比例、心脏骤停时长、CPR总时长、首次电除颤实施时间、电除颤次数、肾上腺素用量、阿托品用量均低于/少于无效组,心源性心脏骤停患者比例高于无效组(P0.05)。回归分析结果显示,年龄、心脏骤停时长、首次电除颤实施时间是影响CPR效果的危险因素。结论年龄低于60岁、心脏骤停时间较短、首次电除颤实施较早的患者,自主循环恢复率较高,CPR总时长较短,复苏药物用量较少。     

门急诊心脏骤停50例抢救体会

目的:探讨门急诊心脏骤停患者的临床特征及影响心肺复苏成功的相关因素。方法对我院50例发生于门(急)诊室、转运中、辅助科室的心脏骤停病例进行回顾性分析。结果:本组50例中即刻复苏成功率30例,占60%;痊愈出院28例,占56%;死亡22例,占44%。复苏效果与心脏骤停发生地点,是否被目击,目击人员类别,标准CPR及电除颤开始时间,二者的顺序及有机结合,参加抢救人员数量,以及致心脏骤停的心律失常类型有关。结论 :即刻开始标准CPR;另一人以最快速度准备除颤仪并除颤;尽量连续,不中断CPR;训练有素、配合默契、技术过硬的抢救团队,是院内心脏骤停复苏成功的关键因素。可除颤心律失常是重要的先决条件。抢救室抢救成功率最高;转运中、辅助科室是心脏骤停抢救的薄弱部位。     

心脏骤停患儿不同时机气管插管对心肺复苏成功率的影响

目的对心脏骤停患儿在不同时机实施气管插管心脏复苏(CPR)的成功率进行探析。方法回顾分析2015年2月‐2017年2月该院急诊的85例心脏骤停患儿的临床资料,依照气管插管时机不同分成A组(5个循环常规CPR后)、B组(10个循环常规CPR后)及C组(15个循环常规CPR后),分别为25例、31例和29例,对比分析3组自主循环恢复和心肺复苏成功情况。结果 A组自主循环恢复率为68.0%,心肺复苏成功率为60.0%,B组分别为64.5%、58.1%,C组分别为37.9%、31.0%,A、B两组比较差异无统计学意义(P0.05),A、B两组与C组比较差异均有统计意义(P0.05);A、B两组CPR成功患儿的平均动脉压(MAP)、血氧饱和度(Sp O2)比较差异无统计学意义(P0.05),但与C组比较差异有统计意义(P0.05)。结论对心脏骤停患儿在实施5~10个循环常规CPR后实施气管插管CPR成功率最高,且血气状况显著改善,值得临床实践。     

心血管病病人围术期心跳骤停原因分析与心肺复苏

目的 分析并探讨通过心肺复苏(CPR)救治心脏骤停病人的抢救措施及效果.方法 对我院自2008年12月至2011年4月期间通过心肺复苏(CPR)救治的18例心脏骤停病人临床资料进行分析.结果本组全部18例心脏骤停患者中,成功抢救5例,占总人数的27.78%.复苏失败病人共计13例,其中广泛前壁心梗伴休克者4例;冠心病心肌梗死去卫生间时出现心脏骤停者3例;采用心脏三联针抢救3例因用药时间晚而造成复苏失败;风心病扩大伴心衰者、马凡综合征者及扩张性心肌病晚期者各1例.结论 配备齐全的复苏设备、技术熟练的复苏队伍、掌握全面的急救知识以及正确的急救措施是提高院前心脏骤停抢救成功率的关键.     

心脏骤停后血管对肾上腺素反应性变化的研究

心肺复苏(CPR)技术的不断发展。使心脏骤停患者得到了及时有效救治。在CPR中使用肾上腺素(Ad)虽已有近50年历史，但其在CPR中的用量仍有争议。2000年8月15日，美国心脏协会(AHA)在circulation杂志上颁布了新的“国际心肺复苏与心血管急救指南2000”，新指南在关于心脏骤停中应用肾上腺素药物方面未做大改动。大剂量肾上腺素抢救心脏骤停是近年来心脏复苏的热门话题之一，     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.