心脏骤停心肺复苏49例临床分析

目的分析心脏骤停患者心肺复苏的成功率。方法对2006年7月～2010年3月我院抢救的49例心脏骤停患者的临床资料、抢救措施及复苏成功率进行回顾性分析。结果 49例患者复苏成功率为20.4%,死亡率为79.6%。院内和院前发生呼吸心脏骤停的患者,复苏成功率分别为30.8%和8.7%,差异有统计学意义（P〈0.01）。复苏开始时间〈5 min和≥5 min的患者复苏成功率分别为32.1%和4.8%,差异亦有统计学意义（P〈0.05）。结论心肺复苏成功率较低,尤其是院前发生呼吸心脏骤停的患者,应普及心肺复苏知识,缩短复苏开始时间,加强急救体系建设,以期提高复苏成功率。     

心源性猝死患者家属行基础心肺复苏对抢救成功率的影响

目的: 多中心、前瞻性研究观察并分析家属行基础心肺复苏对心脏骤停患者救治成功率的影响。 方法: 连续入选2006年5月~2007年12月,在北京市3个医院就诊的患者共127例。分为家属行基础心肺复苏组（A组）和未行基础心肺复苏组（B组）。比较两组抢救成功率,并对患者家属（414人）进行心肺复苏技术现况与需求的问卷调查。结果: 127例患者中,A组27例(21.3%);B组100例(78.7%)。A组的心肺复苏成功率显著高于B组（22% vs. 7%,P<0.01）,影响心肺复苏成功的因素包括:家属是否参与心肺复苏、开始心肺复苏的时间、操作是否规范有效等。结论: 家属行心肺复苏的抢救成功率优于未行心肺复苏者;目前家属对心肺复苏技术的需求量大,掌握率低,急需普及,普及的关键是规范化培训。     

院内猝死患者心肺脑复苏抢救中个体化心肺复苏的应用价值

目的探讨个体化心肺复苏在院内猝死患者心脑复苏抢救中的应用价值。方法选取我院2011年1月至2014年6月间治疗监护中发生猝死的患者450例,所有患者均行个性化心肺复苏,作为实验组观察,选取2010年以前行常规心肺复苏的450例患者作为对照组,比较两组即刻复苏成功率和存活率。结果实验组患者即刻复苏成功率为18.67%(84/450),存活率为8.89%(40/450),均明显高于对照组,差异具有统计学意义。结论猝死患者心肺脑复苏抢救中应用个体化心肺复苏可有效地提高即刻复苏成功率和存活率,临床应用价值显著。     

纳洛酮在37例心肺脑复苏中的应用疗效

目的探讨纳洛酮在37例心肺脑复苏中的应用疗效。方法 2012年2月到2014年3月我院收治突发心跳骤停患者共73例,并随机分为对照组（n=36例）和观察组（n=37例）。两组均给予常规心肺复苏措施,在此基础上给予观察组纳洛酮治疗。对比两组的复苏情况、复苏成功率以及48h生存率。结果观察组在自主循环恢复率、自主呼吸恢复率均高于对照组（χ2自主循环恢复率=7.439,P=0.006;χ2自主呼吸恢复率=7.820,P=0.005）,意识恢复时间低于对照组（t意识恢复时间=6.250,P=0.000）。观察组的复苏成功率、48h生存率分别为51.4%、45.9%,对照组分别为22.2%、16.7%,观察组均显著高于对照组（χ2复苏成功率=6.643,P=0.010;χ2生存率=7.249,P=0.007）。结论在心肺脑复苏过程中,应用纳洛酮能够改善患者的呼吸循环,提高复苏成功率和生存率,应大力推广。     

心肺复苏机在急诊心脏骤停患者救治中的临床应用效果分析

目的观察分析心肺复苏机在急诊心脏骤停患者救治中的临床应用效果。方法选择2017年10月-2019年4月在我院进行治疗的心脏骤停患者84例作为分析对象,通过随机数字法对其进行分组,分为对照组与分析组,各42例,对照组患者采取人工徒手心肺复苏,分析组患者采取心肺复苏机进行心肺复苏,比较分析两组患者的复苏有效率与术后恢复情况。结果分析组患者心肺复苏有效15例,有效率为35.71%,对照组心肺复苏有效7例,有效率为16.67%,分析组患者有效率明显高于对照组(P<0.05);分析组患者舒张压与收缩压明显高于对照组(P<0.05),心肺复苏时间、恢复自主呼吸时间明显短于对照组(P<0.05)。结论对心脏骤停的患者采取心肺复苏机进行心肺复苏具有较高的复苏成功率,可有效促进预后。     

心肺复苏电除颤前抢救措施的对比研究

目的 探讨住院心脏骤停患者心肺复苏电除颤前的更有效措施。方法 选择住院心脏骤停患者113例,根据心肺复苏电除颇前采取的不同措施分为两组,一组为电除颤前给予人工通气,包括口对口人工呼吸和气管插管加胸外心脏按压,称常规组,共44例,男36例,女8例,年龄35-67岁,平均54±11岁;另一组为电除颤前给予单纯胸外心脏按压,称观察组,共69例,男性56例,女性13例,年龄34-77岁,平均56±12岁。结果 常规组复苏成功21例,成功率为47.7%,出院存活15例,出院存活率为34.1%;观察组复苏成功48例,成功率为69.6%,出院存活33例,出院存活率为55.1%;两组复苏成功率和出院率分别进行相比,P值均相似文献   

兔模型心脏骤停标准的探讨

目的：比较心肺复苏动物模型的2种心脏骤停判断标准,以确立适合于心脏骤停后综合征研究的心脏骤停判断标准。方法：大耳白兔30只,随机分为心电图标准组（A组）、动脉压标准组（B组）。采用夹闭气管建立心脏骤停模型,分别使用2种不同的心脏骤停判断标准,心脏骤停5min时立即复苏,观察复苏成功率和兔存活时间,监测心脏骤停前、复苏后24、48、72、96、120h6个时间点兔血神经元特异性烯醇化酶（NSE）、谷丙转氨酶（ALT）、血肌酐及肌钙蛋白I水平,分析复苏后多器官功能障碍综合征（MODS）发生情况。结果：心肺复苏即刻成功率A组为33%,B组为86%,2组比较有显著差异（P〈0.05）。兔存活时间A组为（1.38±1.04）h,B组存活时间为（58.0±41.5）h,2组比较有显著差异（P〈0.01）。B组兔复苏后24、48、72h时间点血NSE、ALT、肌酐及肌钙蛋白I水平明显升高,与心脏骤停前比较有显著差异（P〈0.01）。复苏后24～72h,兔出现多器官功能障碍综合征（MODS）表现。结论：以平均动脉压为标准判断心脏骤停优于心电图标准,适用于标准化心脏骤停后综合征的兔模型的建立。     

心肺复苏中氨茶碱与肾上腺素联合应用的疗效

目的探讨联合应用肾上腺素和氨茶碱在心肺复苏早期的临床疗效。方法观察120例在该院急诊科、老年病科、ICU病房进行心肺复苏患者的临床资料,其中40例患者在心肺复苏中使用标准剂量的肾上腺素抢救为标准剂量组,40例使用大剂量肾上腺素抢救为大剂量组,40例应用肾上腺素联合氨茶碱抢救为联合组。比较三组复苏疗效、自主循环恢复时间和格拉斯哥昏迷评分结果。结果联合组自主循环恢复率、24 h存活率、出院存活率均显著高于大剂量组和标准组(P0.05);并且自主循环及自主呼吸恢复时间短于大剂量组和标准计量组(P0.05)。结论在抢救心脏停搏病人流程中应用肾上腺素联合氨茶碱能明显提高患者心肺复苏的自主循环恢复率及提高存活率并能维持其稳定性。     

面罩联合插管在急诊抢救老年心肺复苏患者的疗效

目的评价面罩联合插管在急诊科院前和院内抢救老年心肺复苏患者的疗效。方法老年呼吸心搏骤停患者126例随机分成面罩联合插管组、插管组和面罩组,比较经皮血氧饱和度(SaO2)、平均动脉血压、自主循环恢复、心肺复苏和存活情况。结果经过急救后,3组间经皮SaO2和平均动脉压差异均显著(P<0.05),面罩联合插管组经皮SaO2和平均动脉压均高于插管组和面罩组(P<0.05);面罩联合插管组自主循环恢复率、心肺复苏率和存活率分别为78.6%、45.2%和33.3%,均显著高于插管组和面罩组(P<0.05)。结论急诊科院前和院内采取面罩联合插管进行老年心肺复苏安全有效,有助于患者自主循环恢复,提高心肺复苏成功率,减少伤亡,提高存活率。     

心肺复苏机与徒手心肺复苏临床疗效的研究

目的 分析使用心肺复苏机与徒手心肺复苏抢救心脏呼吸骤停患者的临床疗效.方法 选取来院心脏呼吸骤停的87例患者为研究对象,其中49例均采用CPR model 心肺复苏,为实验组;其余38例采用徒手心肺复苏,为对照组.结果 实验组平均动脉压、血氧分压、血氧饱和度、有效率均显著优于对照组(P<0.05),并发症发生率显著低于对照组(P<0.05),而两组间复苏成功率无显著性差异(P>0.05).结论 心肺复苏机比徒手心肺复苏能更好的改善心脏呼吸骤停患者的平均动脉压、血氧分压、血氧饱和度,但不能挽救更多的患者生命.     

Bystander CPR in prehospital coarse ventricular fibrillation

Prehospital bystander cardiopulmonary resuscitation (CPR) was studied to determine if it affected the outcome of defibrillation. Four hundred twenty-one consecutive witnessed cardiopulmonary arrests presenting with the initial rhythm of coarse ventricular fibrillation treated by the Milwaukee County Paramedic System from January 1980 to June 1982 were analyzed. Pediatric, trauma, and poisoning patients and those receiving intravenous or endotracheal medications before defibrillation (58) were excluded. Immediate professional bystander CPR (physician, nurse, EMT) and citizen bystander CPR were compared to a control group receiving no bystander CPR until arrival of EMS personnel. A successful defibrillation occurred if defibrillation prior to administration of medication produced an effective cardiac rhythm with pulses. Eighty-eight of the 363 remaining patients (24%) converted with initial defibrillations. While the group receiving professional bystander CPR had a higher successful defibrillation rate than did the no-CPR group (35% vs 22%, P less than .04), citizen bystander CPR and no-CPR groups had similar successful defibrillation rates (24% vs 22%, no significant difference). One hundred eighty-six of the 363 patients (51%) were transported to a hospital with a rhythm and a pulse (a successful resuscitation). Ninety-seven of the 363 patients (27%) were discharged alive from the hospital (a save). Patients who were converted successfully using initial "quick-look" defibrillations were far more likely to be successfully resuscitated (79/88 [90%] vs 107/275 [39%], P greater than .0001) and to be discharged alive from the hospital (54/88 [61%] vs 43/275 [16%], P greater than .0001) than were those who required further advanced cardiac life support techniques.(ABSTRACT TRUNCATED AT 250 WORDS)     

急性心肌梗死合并心原性休克患者住院期间结果及影响因素分析

目的探讨影响急性心肌梗死(AMI)合并心原性休克(CS)患者住院期间死亡的因素。方法回顾性分析2002年4月至2019年4月于首都医科大学附属北京朝阳医院心脏中心接受治疗的321例AMI合并CS患者的临床资料。将患者分为院内死亡组(230例)和院内生存组(91例)。比较两组患者的基线特征、冠状动脉造影和介入治疗特征、心功能和生化指标。结果与院内生存组相比,院内死亡组患者年龄偏大,院前时间偏长,非ST段抬高型心肌梗死比例偏高;三支冠状动脉病变发生率高,实施心肺复苏比例高,急诊经皮冠状动脉介入治疗(PCI)率偏低;血清肌酐和B型脑钠肽显著增高。两组主动脉内球囊反搏(IABP)置入率相当(82.3%比86.8%,P=0.349)。两组左心室射血分数、肌钙蛋白I峰值、低密度脂蛋白胆固醇、白细胞计数、红细胞沉降率和C反应蛋白比较,差异均无统计学意义(均P>0.05)。logistic多因素回归分析显示,年龄(OR 1.005,95%CI 0.992~1.212,P=0.047)、院前时间(OR 0.898,95%CI 0.991~1.006,P=0.048)、急诊PCI(OR 0.331,95%CI 0.103~3.521,P=0.039)和实施心肺复苏(OR 7.238,95%CI 1.620~32.343,P=0.010)是AMI合并CS住院期间死亡的独立预测因素。结论IABP置入不影响AMI合并CS住院期间生存率。年龄、院前时间、急诊PCI和实施心肺复苏是住院期间死亡的独立预测因素。     

Dispatcher-assisted cardiopulmonary resuscitation. Validation of efficacy

Dispatcher-delivered telephone instruction in cardiopulmonary resuscitation (CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. We tested the efficacy of a previously developed CPR message using a recording mannikin in a high stress, simulated cardiac arrest scenario. Community volunteers were unaware they would perform CPR until immediately before each trial. Performance of volunteers without prior CPR training (group A, n = 65) who received telephone instruction was compared with that of previously trained volunteers (group B, n = 43) who received the same message. Performances of both groups were also compared with a third group (group C, n = 43) composed of previously trained volunteers who did not receive the message. Quality of CPR was graded by three CPR instructors using explicit criteria. Printout strips from the recording mannikins were also analyzed. Evaluators were unaware of the training status of volunteers. The three groups were of comparable sex, race, and educational level, but group C was significantly younger than groups A and B (31.7 vs. 37.7 years, p less than 0.001). Because of the time required for telephone instruction, groups A and B started chest compressions a mean of 4.0 minutes after collapse compared with 1.2 minutes for group C (p less than 0.0001). We found that the previously untrained volunteers of group A performed CPR of an overall quality comparable to that performed by previously trained members of group C. Group A performed chest compressions significantly better than group C (p less than 0.02) but had greater problems performing effective ventilations.(ABSTRACT TRUNCATED AT 250 WORDS)     

参附注射液改善心肺复苏后病人生存率的Meta分析

目的系统评价参附注射液辅助治疗对心肺复苏病人生存率的影响。方法检索MedLine、EMbase、Cochrane Library、中国生物医学文献数据库、中国知网(CNKI)、万方数据库、维普数据库,纳入参附注射液辅助治疗心肺复苏的随机对照试验(RCT),试验组应用参附注射液加常规心肺复苏治疗,对照组应用常规心肺复苏治疗,采用Cochrane Handbook 5.1.0进行质量评价与数据检测,利用RevMan 5.3进行Meta分析。结果纳入17项RCT,涉及2296例病人。心肺复苏后2 d、7 d、14 d、28 d、90 d试验组生存率明显高于对照组,差异均有统计学意义(P<0.05)。而心肺复苏后4 h、6 h、1 d、3 d两组生存率比较,差异均无统计学意义(P>0.05)。结论当前证据表明,在常规心肺复苏基础上加用参附注射液辅助治疗,能够改善心肺复苏后病人中远期(>7 d)生存率。     

Cardiopulmonary bypass vs CPR as treatment for prolonged canine cardiopulmonary arrest

Although in vitro studies have demonstrated functional recovery of neurons after prolonged ischemia, in vivo experience with patients resuscitated from cardiopulmonary arrest demonstrates much less cerebral resistance to global ischemia. The purpose of our investigation was to compare the effectiveness of femoro-femoral veno-arterial cardiopulmonary bypass (CPB) to standard cardiopulmonary resuscitation in the treatment of prolonged cardiopulmonary arrest. Ten mongrel dogs were electrically fibrillated and left in cardiopulmonary arrest without any therapy for 12 minutes. Subsequently, either CPB (n = 5) or CPR (n = 5) was initiated and resuscitation attempted according to a standardized protocol that included administration of the calcium channel blocker lidoflazine in an effort to optimize cerebral and myocardial recovery. If there was return of spontaneous circulation, the animal was managed in an intensive care setting with invasive hemodynamic monitoring and ventilatory support for up to nine hours. Neurologic function was graded using a standardized neurologic deficit scoring (NDS) system at 12 hours after insult and daily for one week or until death. Prearrest hemodynamic and metabolic parameters were comparable in both groups (P greater than .05). All CPB animals were resuscitated successfully and alive at 24 hours after insult as opposed to none in the CPR group (P less than .005). In addition, three of the CPB animals were neurologically normal at final grading with NDS scores of zero. The other two CPB animals had persistent severe neurologic impairment and a mean NDS score of 51%. Thus CPB is more effective than CPR in the treatment of prolonged cardiopulmonary arrest. The improved outcome probably results primarily from improvement in blood flow with CPB.(ABSTRACT TRUNCATED AT 250 WORDS)     

丹红注射液对心肺复苏患者早期凝血功能的影响

目的 探讨丹红注射液对心肺复苏（CPR）患者早期凝血功能的影响。方法 72例CPR患者随机分为试药组（n=37）、复苏组（n=35）,试药组再灌注后在常规复苏基础上予丹红注射液,观察2组凝血功能指标及APACHEⅡ评分的变化。结果 试药组治疗后活化部分凝血活酶时间（APTT）、血浆凝血酶原时间（PT）、血浆凝血酶时间（TT）、纤维蛋白原（FIB）、血小板平均体积（MPV）、APACHEⅡ评分与较试药组治疗前及与复苏组治疗后比较降低（P<0.05）,血小板计数（PLT）增高（P<0.05）。结论 丹红注射液能有效减少心肺复苏再灌注凝血异常的发生,改善预后。     

CPR training in the community

To provide a profile of potential rescuers of cardiac arrest victims, 1,271 randomly selected subjects were interviewed by telephone. Thirty-nine percent had formal instruction in cardiopulmonary resuscitation (CPR), 90% knew the emergency telephone number (911), and 5% had performed CPR. Subjects with training were significantly younger than those without (36 vs 48 years old) (P less than .001), and they had a lower incidence of known heart disease in family members (7% vs 15%) (P less than .001). More men than women were trained in CPR (44% vs 37%) (P less than .015). We recommend that efforts be undertaken to reach target groups of middle-age and older women for CPR training, and that physicians assume an active role in encouraging families of cardiac patients to learn this procedure.     

Use of cardiopulmonary bypass, high-dose epinephrine, and standard-dose epinephrine in resuscitation from post-countershock electromechanical dissociation.

STUDY OBJECTIVE: To determine the effects of cardiopulmonary bypass with standard-dose epinephrine, high-dose epinephrine, and standard-dose epinephrine on perfusion pressures, myocardial blood flow, and resuscitation from post-countershock electromechanical dissociation. DESIGN: Prospective, controlled laboratory investigation using a canine cardiac arrest model randomized to receive one of three resuscitation therapies. INTERVENTIONS: After the production of post-countershock electromechanical dissociation, 25 animals received ten minutes of basic CPR and were randomized to receive cardiopulmonary bypass with standard-dose epinephrine, high-dose epinephrine, or standard-dose epinephrine. MEASUREMENTS AND MAIN RESULTS: Myocardial blood flow was measured using a colored microsphere technique at baseline, during basic CPR, and after intervention. Immediate and two-hour resuscitation rates were determined for each group. Return of spontaneous circulation was achieved in eight of eight cardiopulmonary bypass with standard-dose epinephrine compared with four of eight high-dose epinephrine and three of eight standard-dose epinephrine animals (P less than .04). One animal was resuscitated with CPR alone and was excluded. Survival to two hours was achieved in five of eight cardiopulmonary bypass with standard-dose epinephrine, four of eight high-dose epinephrine, and three of eight standard-dose epinephrine animals (NS). Coronary perfusion pressure increased significantly in the cardiopulmonary bypass with standard-dose epinephrine group when compared with the other groups (cardiopulmonary bypass with standard-dose epinephrine, 76 +/- 45 mm Hg; high-dose epinephrine, 24 +/- 12 mm Hg; standard-dose epinephrine, 3 +/- 14 mm Hg; P less than .005). Myocardial blood flow was higher in cardiopulmonary bypass with standard-dose epinephrine and high-dose epinephrine animals compared with standard-dose epinephrine animals but did not reach statistical significance. Cardiac output increased during cardiopulmonary bypass with standard-dose epinephrine (P = .001) and standard-dose epinephrine (NS) compared with basic CPR but decreased after epinephrine administration in the high-dose epinephrine group (NS). CONCLUSION: Resuscitation from electromechanical dissociation was improved with cardiopulmonary bypass and epinephrine compared with high-dose epinephrine or standard-dose epinephrine alone. However, there was no difference in survival between groups. Cardiopulmonary bypass with standard-dose epinephrine resulted in higher cardiac output, coronary perfusion pressure, and a trend toward higher myocardial blood flow. A short period of cardiopulmonary bypass with epinephrine after prolonged post-countershock electromechanical dissociation cardiac arrest can re-establish sufficient circulation to effect successful early resuscitation.     

Immediate countershock versus cardiopulmonary resuscitation before countershock in a 5-minute swine model of ventricular fibrillation arrest

STUDY OBJECTIVE: Prior laboratory and clinical studies demonstrate that cardiopulmonary resuscitation (CPR) preceding countershock of prolonged ventricular fibrillation (VF) increases the likelihood of successful cardiac resuscitation. The lower limit of VF duration at which time preshock CPR provides no benefit has not been specifically studied. The purpose of this study was to compare countershock and cardiac resuscitation outcome between immediate countershock of VF of 5-minute duration and CPR without drug therapy before countershock in a swine model. METHODS: VF was induced in anesthetized and instrumented swine. After 5 minutes of VF, animals received 1 of 2 treatments. Animals in group 1, a "historical" control group (n=20), received immediate countershock followed by CPR and repeated shocks if needed. Group 2 animals (n=11) received CPR for 90 seconds preceding countershock, then continued CPR and repeated countershock if necessary. Drugs were not administered to either group, and resuscitation efforts were discontinued if a perfusing rhythm was not restored within 10 minutes of the first countershock. First shock success rate (defined as termination of VF), the number of shocks required to terminate VF, and the cardiac resuscitation rate were compared between groups. RESULTS: The first shock terminated VF in 13 of 20 group 1 animals and 2 of 11 group 2 animals (P =.023). All but 1 animal in group 1 developed pulseless electrical activity after countershock. All but 1 animal in group 1 were eventually successfully resuscitated with CPR and repeated shocks if necessary. Four group 2 animals could not be resuscitated (P =.042). CONCLUSION: Although effective in improving outcome of prolonged VF, CPR preceding countershock of VF of 5-minute duration does not improve the response to the first shock, decrease the incidence of postshock pulseless electrical activity, or the rate of return of circulation. In this study, CPR preceding countershock resulted in a significantly lower cardiac resuscitation rate.     

Thumper型CPR机对心脏复苏的疗效分析

目的探讨Thumper型CPR机对心脏停搏患者心肺复苏(CPR)的临床效果。方法将我院急诊科重症监护病房中发生心脏停搏的患者107例随机分为两组,对照组52例采用徒手胸外心脏按压,两人交替,CPR机组55例采用Thumper型CPR机进行胸外心脏按压,两组均按照《2005年国际CPR和心血管急救指南》进行急救,比较两组患者心脏复苏成功率,复苏成功时间,有创动脉血压,动脉血氧饱和度,动脉血氧分压,肋骨骨折发生率。结果 CPR机组心脏复苏成功率,有创动脉血压,血氧饱和度,动脉血氧分压明显优于对照组,差异具有统计学意义(P<0.05);CPR成功时间,肋骨骨折发生率明显低于对照组,两组差异具有统计学意义(P<0.05)。结论心脏停搏患者早期采用Thumper型CPR机进行心脏复苏,能显著提高CPR成功率,降低并发症的发生。