使用静脉泵输入肾上腺素在心肺复苏中的效果

目前肾上腺素是公认抢救心脏骤停最有效的药物〔1〕。心肺复苏(CPR)时尽快建立静脉通路与呼吸通道、尽早实施人工胸外心脏按压与心电监护、及时心脏电击除颤与肾上腺素等药物的合理应用是CPR成功的关键〔2〕。本文就CPR时采用静脉泵输入肾上腺素和静脉推注标准剂量肾上腺素对复苏成功率进行对比,观察如何获取最好的临床救治率。     

心脏骤停患者心肺复苏程序的探讨

目的 探讨心脏骤停患者的心肺复苏的程序,以便为心肺复苏提供更多的复苏途径.方法 选择近年来心肺复苏成功的39例心脏骤停患者,根据不同情况采取相应的五种不同复苏程序:ABCD、D、C、CD、CABD.结果13例呼吸完全停止的患者采用传统ABCD复苏程序;26例呼吸尚存的患者,7例现场直接给予电除颤(D),其余19例现场不具备立即除颤的,立即给予胸外心脏按压,其中3例通过心脏按压直接复苏(C),9例心脏按压再电除颤后复苏(CD),7例心脏按压时间较长,呼吸逐渐停止,给予人工通气、复苏药物及电除颤最终复苏(CABD).结论对原发性心跳骤停的患者应视不同情况采取不同的复苏程序.     

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   

心跳骤停复苏成功18例临床体会

1992年 7月～ 2 0 0 1年 12月 ,笔者抢救 18例心脏骤停患者均获成功。现将救治体会报告如下。临床资料 :本组男 12例 ,女 6例 ;年龄 2 0～ 72岁 ,平均 41岁。心搏停止发生在院外者 2例 ,院内者 16例。心肺复苏前心跳停止时间 1～ 8min,平均 4.2 min。心肺复苏开始至心脏复跳 2～5 0 min,平均 10 .3 min。其中冠心病 9例 ,扩张性心肌病 5例 ,有机磷中毒 2例 ,电击伤、风湿病各 1例。抢救方法与结果 :心肺复苏术现场抢救包括气道畅通、吸氧、人工呼吸、心前区捶击、胸外心脏按压 ,并静注肾上腺素 1～ 3 mg/次 ,每 3～ 5 min重复使用 ,电击除颤…     

用两维超声心动图观察胸外心脏按压时人心脏瓣膜的活动——探讨血流机理

胸外心脏按压和气道通气可在除颤和/或用心血管药物前维持心脏骤停患者的一定程度的灌注和氧合,但对心肺复苏期间血液向前流动的机理仍有疑义。主要争论点是血液向前流动究系直接机械     

胺碘酮和硫酸镁联合治疗顽固性室颤的病例分析

心脏骤停是临床上常见的紧急事件,其中室颤占心脏性猝死的60%～80%[1].抢救室颤最有效的方法是电除颤恢复窦性节律.在抢救过程中常见到经反复电除颤,肾上腺素,胸外心脏按压,室颤仍反复发作,针对这种顽固性室颤,从2005年起,我科将大剂量胺碘酮和硫酸镁应用于顽固性室颤中,取得了较好的疗效,大大提高了复苏的成功率.5年来我科共成功复苏十余例患者,现介绍两例复苏成功的患者.     

基层医院抢救心脏骤停的体会

1986年以来,我们抢救心脏骤停10例15次,其中7例12次抢救成功。体会如下: 1.心肺复苏开始的时间是复苏成败的关键。本组复苏成功者均在骤停后3分钟内进行。复苏越早,效果越好,神志清醒越快。2.及时有效地进行胸外心脏按压是复苏成功的重要一环。本组1例单纯胸外心脏按压即复苏成功;2例次胸外心脏按压配合静脉注射利多卡因复苏成功;另1例胸外心脏     

2005年心肺复苏指南解读

复苏医学是临床医学中进展较快的领域之一。美国《循环》杂志于2005年底发表了美国心脏学会(American Heart Association,AHA)新修订的心肺复苏与心血管急救指南(CPR&ECC)。新指南对2000年复苏指南内容作了修改或补充,例如将胸外按压与通气之比由15:2或5:1改为30:2;胸外按压要有力、快速、让胸廓弹回、减少按压中断;不再强调先电击除颤,公共场所有自动体表除颤仪     

大剂量肾上腺素、纳络酮抢救心脏骤停20例体会

１９９３～１９９８年，我院急诊科抢救心脏骤停患者４０例。现将救治体会报告如下。临床资料：本组男２９例，女１１例；年龄４８～７６岁，平均６２岁。其中冠心病２６例，心肌病４例，脑血管病４例，电击３例，药物中毒２例，溺水１例。心脏骤停＜５分钟者３例，５～１０分钟者３０例，＞１０分钟者７例。心电图表现心室颤动３４例，心电机械分离４例，心室静止２例。随机平分为两组，两组的年龄、病史、心脏骤停时间无明显差异。大剂量肾上腺素组除抢做气管插管、机械通气、胸外按压、电击除颤外，静注大剂量肾上腺素（按３０ｍｇ，…     

心肺复苏后溶栓治疗抢救急性心肌梗死二例

1病例简介 患者1,女,42岁,2006年12月晨练时突发胸闷、呕吐、晕厥,由120送入我院急诊室,随即发生心脏骤停、室颤,立即予心肺复苏（胸外心脏按压,气管插管,360J电除颤3次）,12min后恢复窦性心律,     

Herz-Kreislaufstillstand im Krankenhaus

Since the 1960s, cardiopulmonary resuscitation is the recommended treatment for patients with cardiac arrest. Although this has been taught to both medical staff and the general population, the prognosis of patients with cardiac arrest remains grim. Surprisingly, the results with respect to survival and functional capacity of in-hospital cardiac arrest with subsequent cardiopulmonary resuscitation do not differ from out-of-hospital data. In the past, a number of risk factors for sudden cardiac death have been identified. Moreover, besides chest compression prompt defibrillation has been emphasized as the intervention of choice to save a patient’s life. Recently utilizing the data from two large registries the impact of a) delay in defibrillation (i.e., defibrillation within 2 min vs longer than 2 min after cardiac arrest, and b) time of the day and day of the week (with respect to the weekend) on survival figures and functional patient outcome have been evaluated. Both analyses have convincingly demonstrated the dependency of clinical outcomes (i.e. survival) from in-hospital structures and processes. Obviously structure elements such as on site availability of specifically trained physicians and nurses is of utmost importance for patient survival.     

Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome

Successful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonary resuscitation (CPR), effective defibrillation strategies and organised post-resuscitation care. The initiation of bystander CPR followed by a prompt emergency response that delivers high quality CPR is critical to outcomes. The integration of additional tasks such as defibrillation, airway management, vascular access and drug administration should avoid interruptions in chest compressions. Evidence for the routine use of CPR prompt/feedback devices, mechanical chest compression devices and pharmacological therapy is limited.     

Perspectives and new approaches for improving cardiopulmonary resuscitation in adults beyond current guidelines

Setting clear priorities for the sequence and importance of actions during cardiopulmonary resuscitation (CPR) is of utmost importance for future guidelines. Unless performed under the rare condition of hypoxic arrest, combined compression and ventilation is usually not necessary in one-rescuer resuscitation of adults. After notifying the emergency medical services (EMS), precordial compression at a rate of 100/min is just as effective or may even be preferable in the majority of cases caused by arrhythmic arrest. Considering the pathophysiological and experimental evidence, chest compression has proven to be more important, even in multi-rescuer settings, than resuscitation ventilation with its problems and risks. International recommendations for compression without respiration for rescuers unwilling to perform resuscitation ventilation or for so-called telephone CPR were not included in the guidelines of the European Resuscitation Council (ERC) probably for reasons of brevity and simplification. However, training for basic cardiopulmonary resuscitation of adults with cardiac arrest should also stress the importance of chest compression over ventilation. Moreover, current studies controversially discuss the optimal time point of defibrillation after collapse. These findings point to the enormous demand for research in the field of cardiopulmonary resuscitation.     

Out-of-hospital resuscitation in East Sussex: 1981 to 1989.

OBJECTIVE--To assess the impact of extended training in advanced life support on the outcome of resuscitation. DESIGN--Analysis of the successful resuscitations from 1981 to 1989. SETTING--Brighton and East Sussex. RESULTS--248 patients were resuscitated from cardiac or respiratory arrest in the community and subsequently survived to leave hospital. Their mean age was 64 years and one year survival was 77%. In most cases the cause of collapse was cardiac but 38 (15%) suffered a respiratory arrest. In 140 of the successful resuscitations (56%) collapse occurred before the arrival of the ambulance. Basic life support, with ventilation and chest compression where necessary, was sufficient to revive 35 (14%) of the patients. Defibrillation was also required in 107 patients (43%), and in a further 106 patients (43%) who had prolonged cardiorespiratory arrest requiring endotracheal intubation and the use of several drugs. Review of ambulance forms and case notes showed that in 87 cases (35%) the abilities of the paramedical ambulance staff in advanced resuscitation techniques contributed decisively to the success of resuscitation. These skills are illustrated by eight case reports. CONCLUSIONS--Extended training for ambulance staff increases the likelihood of successful resuscitation from out-of-hospital cardiopulmonary arrest. Though instruction in defibrillation must have the highest priority, full paramedical training can bring appreciable additional benefits.     

Update in cardiopulmonary resuscitation

Despite the passage of 50 years since the introduction of closed chest compression and mouth-to-mouth rescue breathing as the techniques of modern cardiopulmonary resuscitation (CPR), the simple techniques remain the backbone of successful resuscitation of victims of cardiac arrest. In particular, the importance of high quality chest compressions is increasingly clear. Current evidence demonstrates chest compressions should be provided at a rate of 100 compressions a minute to a depth of 4 to 5 cm (1.5 to 2 inches) with full chest recoil between compressions. Additionally, all efforts should be made to minimize interruptions in chest compressions, including single shock defibrillation and elimination of pulse check postdefibrillation in favor of continued chest compressions immediately postshock. The emphasis on high quality chest compressions is echoed in the most recent CPR guidelines of the American Heart Association and the International Liaison Committee on Resuscitation. The role of rescue breathing is currently debated; however, it is likely important in prolonged arrests or those of non-cardiac etiology. Current recommendations encourage inclusion of rescue breaths by trained responders, but allow for elimination of rescue breathing and emphasis on chest compressions for responders untrained or unconfident in rescue breathing. Early defibrillation is a key component to successful resuscitation of ventricular tachycardia and ventricular fibrillation arrest; however, implementation of defibrillation should be coordinated with CPR to minimize interruptions in chest compressions. Aside from early defibrillation, there are no clear adjuncts to CPR that improve survival. However, postresuscitation therapies such as therapeutic hypothermia may become an important part of early resuscitation management as tools to provide hypothermia become increasingly portable and capable of rapid cooling.     

Cardiocerebral resuscitation for cardiac arrest

Survival rates from out-of-hospital cardiac arrest continue to be low despite periodic updates in the Guidelines for Emergency Medical Services and periodic improvements such as the addition of automatic external defibrillators (AEDs). The low incidence of bystander cardiopulmonary resuscitation (CPR), substantial time without chest compressions throughout the resuscitation effort, and a lack of response to initial defibrillation after prolonged ventricular fibrillation contribute to these unacceptably poor results. Resuscitation guidelines are only revised every 5 to 7 years and can be difficult to change because of the lack of randomized controlled trials in humans. Such trials are rare because of a number of logistical difficulties, including the problem of obtaining informed consent. An alternative approach to advancing resuscitation science is for evidence-based demonstration projects in areas that have adequate records, so that one may determine whether the new approach improves survival. This is reasonable because the current guidelines make provisions for deviations under certain local circumstances or as directed by the emergency medical services medical director. A wealth of experimental evidence indicates that interruption of chest compressions for any reason in patients with cardiac arrest is deleterious. Accordingly, a new approach to out-of-hospital cardiac arrest called cardiocerebral resuscitation (CCR) was developed that places more emphasis on chest compressions for witnessed cardiac arrest in adults and de-emphasizes ventilation. There is also emphasis on chest compressions before defibrillation in circulatory phase of cardiac arrest. CCR was initiated in Tucson, Arizona, in November 2003, and in two rural Wisconsin counties in early 2004.     

急性心肌梗塞合并心脏骤停的急救治疗分析

目的：探讨急性心肌梗塞合并心脏骤停的急救方法，分析疗效。方法选取以往10例急性心肌梗塞合并心脏骤停的患者，回顾当时的急救治疗过程，通过对心电的检测情况、早期电击除颤情况、电击除颤时所用药物以及用药的方法和途径进行分析，讨论急救治疗的有效方法，提高复苏成功概率。结果通过对10例患者进行急救，利用电击除颤的方法，观察心电变化情况，进行合理药物治疗，10例患者都得到了及时的抢救，复苏成功，血压得到控制，心跳频率恢复平稳状态，心律逐渐变为窦性。经过后期治疗有9例患者成功出院，有1例患者由于突发性心脏病去世。结论及时观察心电的变化情况，做到早发现，早进行急救，进而成功的救助患者生命，再加上急救之后的护理干预，确保每一个患者顺利康复出院。     

Sudden cardiac arrest in intercollegiate athletes: Detailed analysis and outcomes of resuscitation in nine cases

BACKGROUND: Public access defibrillation programs have demonstrated a survival benefit in persons with out-of-hospital cardiac arrest. However, little is known about the effectiveness of early defibrillation in young competitive athletes with sudden cardiac arrest (SCA). OBJECTIVES: The purpose of this study was to investigate the details and outcomes of resuscitation in a cohort of intercollegiate athletes with SCA. METHODS: Nine cases of SCA in intercollegiate athletes occurring between 1999 and 2005 were identified through prior research and public media. A detailed questionnaire was completed by the certified athletic trainer involved in the resuscitation, and direct phone follow-up was achieved in every case. RESULTS: Nine intercollegiate athletes with SCA (4 basketball, 2 football, 2 lacrosse, and 1 swimming) had an average age of 21 years (range 18-30 years). All 9 athletes had a witnessed collapse, 7 occurred during practice, 1 during competition, and 1 during organized weight training. Cardiopulmonary resuscitation (CPR) was initiated within 30 seconds after cardiac arrest in 6 cases and by 1 minute in 2 additional cases. An automated external defibrillator (AED) was provided by an athletic trainer in 5 cases and by arriving emergency medical services (EMS) in 4 cases. The initial cardiac rhythm was confirmed or suspected ventricular fibrillation in 7 athletes, pulseless idioventricular rhythm in 1 case, and unknown in 1 case. In 7 cases a shock was deployed, with an average time from cardiac arrest to defibrillation of 3.1 minutes (range 1-7.5 minutes). The average time from arrest to defibrillation decreased significantly if an AED was provided by an athletic trainer as compared with the responding EMS (1.6 vs 5.2 minutes; P = .046). Eight of the 9 athletes died. The underlying cause of sudden cardiac death was hypertrophic cardiomyopathy in 5, commotio cordis in 2, and myocardial infarction in 1. Diagnostic studies in the survivor demonstrated no structural heart disease or precise cause of SCA. CONCLUSION: Despite witnessed collapse, immediate CPR, and prompt AED use in most cases, early defibrillation showed limited success, and survival was less than expected in this small cohort of intercollegiate athletes. More research is needed to determine the effectiveness of early defibrillation and factors that affect survival in young athletes with SCA.     

Out‐of‐hospital cardiac arrest: 10 years of progress in research and treatment

Cardiac disease is the most common cause of mortality in Western countries, with most deaths due to out‐of‐hospital cardiac arrest (OHCA). In Sweden, 5000–10 000 OHCAs occur annually. During the last decade, the time from cardiac arrest to start of cardiopulmonary resuscitation (CPR) and defibrillation has increased, whereas survival has remained unchanged or even increased. Resuscitation of OHCA patients is based on the ‘chain‐of‐survival’ concept, including early (i) access, (ii) CPR, (iii) defibrillation, (iv) advanced cardiac life support and (v) post‐resuscitation care. Regarding early access, agonal breathing, telephone‐guided CPR and the use of ‘track and trigger systems’ to detect deterioration in patients' condition prior to an arrest are all important. The use of compression‐only CPR by bystanders as an alternative to standard CPR in OHCA has been debated. Based on recent findings, guidelines recommend telephone‐guided chest compression‐only CPR for untrained rescuers, but trained personnel are still advised to give standard CPR with both compressions and ventilation, and the method of choice for this large group remains unclear and demands for a randomized study. Data have shown the benefit of public access defibrillation for dispatched rescuers (e.g. police and fire fighters) but data are not as strong for the use of automated defibrillators (AEDs) by trained or untrained rescuers. Postresuscitation, use of therapeutic hypothermia, the importance of specific prognostic survival factors in the intensive care unit and the widespread use of percutaneous coronary intervention have all been considered. Despite progress in research and improved treatment regimens, most patients do not survive OHCA. Particular areas of interest for improving survival include (i) identification of high‐risk patients prior to their arrest (e.g. early warning symptoms and genes); (ii) increased use of bystander CPR training (e.g. in schools) and simplified CPR techniques; (iii) better identification of high‐incidence sites and better recruitment of AEDs (via mobile phone solutions?); (iv) improved understanding of the use of therapeutic hypothermia; (v) determining which patients should undergo immediate coronary angiography on hospital admission; and (vi) clarifying the importance of extracorporeal membrane oxygenation during CPR.