心肺复苏新进展

心肺复苏学（resuscitation science）是研究导致机体氧输送突然停止或接近停止的病理状态的流行病学、病理生理、发生机制和急救治疗的一门科学。这种病理状态严重影响心、肺和脑的功能，它是危重病领域的一个重要课题，复苏学尤其强调其发生机制、全身缺氧的实验和临床研究。     

心、肺、脑复苏及其进展

近30年来,在对急性突然循环停止的病理生理和复苏方法研究的基础上,现代复苏医学迅速发展,特别是美国自1974年以来三次有关心肺复苏的会议,制定了心肺复苏的救治     

心脑缺血再灌注损伤与复苏

<正> 近20年来,心肺脑复苏工作有了很大进展。为了提高复苏的成功率,人们从分子水平进一步研究缺血、复苏、再灌注时组织损伤过程和表现,并探索复苏后最佳生命支持方案。缺血时组织损伤机理缺血引起细胞损伤是由缺氧和氧化能量代谢的停止为开始。缺血时细胞生化反应并未停止,此时以还原和酸性环境中进行的反应、代替了氧化和微硷性环境中的高浓度三磷酸腺苷(ATP)所支持、由酶调     

新生儿复苏136例的体会

通过对136例重度窒息,心搏停止新生儿进行心肺现场复苏,成功率100%.本人认为,导致新生儿呼吸循环抑制的直接原因是低氧血症和高碳酸血症,故新生儿以处理窒息缺氧为主,少数心搏停止或苍白窒息伴心率小于80-100次/分者,在呼吸复苏同时,应立即行心脏复苏.通过分析资料,本人认为复苏成功率及预后与复苏是否早期有效进行直接相关,即呼吸心跳恢复越快,复苏成功率就越高,预后越好.做好产前检查,提前做好心肺复苏准备等.新生儿复苏的关键措施在于及时有效建立呼吸,保证氧供应,早期恢复心跳,建立有效循环,同时治疗低血容量,纠正酸中毒,脱水,保暖,预防肺部感染及新生儿颅内出血等.     

复苏后多器官功能障碍综合征的研究进展

复苏后多器官功能障碍综合征(post-resuscitation multiple organ dysfunction syndrome,PR-MODS)是导致心跳骤停患者低出院率的重要原因,加强对PR-MODS的整体认识将有利于准确判断复苏后患者病情并及时调整治疗方案,提高心跳骤停患者出院率.本文综述了PR-MODS提出的历史过程以及与其他原因引起的MODS的异同点、病因、病理、发病机制、诊断和治疗,并展望了未来的研究方向.     

脑死亡与脑复苏

死亡意味着生命的停止。实际上即维持生命所必需的功能停止活动,如呼吸、循环和对内外环境刺激的反应消失。1957年有人提出:当脑功能已经不可恢复时,是否仍有必要对躯体进行复苏,这是值得研究和重视的。一、脑死亡的病因和病理常见的病因是脑肿瘤、脑外伤、脑卒中、严重缺氧、窒息和中枢神经系统感染等引起病人处于无反应性昏迷,自动呼吸停止需用人工呼吸器维持,这类病人死亡之后,进行尸解。1.肉眼观察:约10%脑死亡标本外观可正常。但     

心肺复苏后的全身炎性反应综合征

心跳骤停、心肺复苏时机体经历了应激反应过程 ,不仅神经、内分泌、血管活性物质发生了改变 ,而且在强烈病理刺激下 ,会产生细胞因子、粘附因子的变化有可能发生全身炎性反应综合征 (ＳＩＲＳ) [1] ,是继发性多脏器衰竭导致死亡的重要原因。临床及早判断ＳＩＲＳ的存在 ,对免疫因子的检测有助于心肺复苏成功的判断。1　心跳骤停、心肺复苏的病理生理机制心跳、呼吸停止是临床死亡的标志 ,机体组织代谢尚未完全停止 ,细胞尚能维持微弱的生命活动 ,如果给予及时的抢救 ,尤其是突发性死亡的患者 ,复苏成功率达 5 0 %以上。生命器官是在缺氧和酸…     

急诊复苏患者呼吸心跳停止前高危征象调查

目的探讨急诊复苏患者呼吸、心跳停止前的高危征象，为可能发生呼吸、心跳停止患者的急诊急救提供诊治依据。方法对194例急诊复苏患者呼吸、心跳停止前的临床资料进行回顾性分析，重点是基础疾病、呼吸心跳停止前主诉、症状、体征等资料。结果①急诊呼吸、心跳停止复苏患者以内科基础疾病占绝大多数（89．18％），所有复苏患者总体复苏成功率约为6．70％；②内科基础疾病中，呼吸、心跳停止者以突然发生且无可采集主诉者最多，约占40．46％；有可采集主诉患者中以呼吸困难、胸闷者最多，其次为胸痛、心慌等主诉，前者发生率显著高于后高（P〈0．05）。③呼吸困难、胸闷主诉者基础疾病以呼吸系统疾病为主，胸痛、心慌主诉者以循环系统疾病为主。结论急诊复苏患者以突然发病、无明显可采集主诉最常见；有可采集主诉者中，呼吸困难、胸闷加重是最高危征象，其次为胸痛、心慌等症状。     

2010年心肺复苏指南在心跳骤停患者护理配合中的启示

<正>心脏骤停是指心脏突然停止跳动,造成了有效排血的停止,大动脉搏动与心音消失,重要器官如脑严重缺血、缺氧,导致生命终止。而心肺复苏是对心跳骤停患者所采取的急救措施,也是医护配合抢救治疗研究的热点之一,急诊心肺复苏和有效的护理配合最能体现"时间就是生命"的理念。     

儿童溺水院前院内急救20例临床分析

目的探讨溺水儿童最佳的院前、院内急救方法,提高复苏成功率。方法对近2年我院急诊与PICU救治的20例溺水儿童病例作回顾分析。结果20例患儿中15例在现场进行了人工呼吸及胸外心脏按压。平均到达医院时间0.5￣3小时。至我院急诊时,心肺停止、瞳孔散大者7例;意识障碍者8例;抽搐者1例;完全清醒4例。对心肺停止的7例患儿立即进行复苏。3例急诊室死亡;其余4例均恢复自主循环,其中2例心肺停止30分钟复苏成功,目前基本恢复正常。2例进入PICU后8￣24小时死于多脏器功能衰竭;非心肺停止组13例患儿中4例遗留轻度缺氧性脑病,其余均治愈出院。结论及时的现场心肺复苏、完善的转运机制、一体化的急救体系,是提高复苏成功率、降低伤残率的有效保障。溺水的预防应关注高危人群,加强安全教育。     

One principle and three fallacies of disability studies

My critics in this symposium illustrate one principle and three fallacies of disability studies. The principle, which we all share, is that all persons are equal and none are less equal than others. No disability, however slight, nor however severe, implies lesser moral, political or ethical status, worth or value. This is a version of the principle of equality. The three fallacies exhibited by some or all of my critics are the following: (1) Choosing to repair damage or dysfunction or to enhance function, implies either that the previous state is intolerable or that the person in that state is of lesser value or indicates that the individual in that state has a life that is not worthwhile or not thoroughly worth living. None of these implications hold. (2) Exercising choice in reproduction with the aim of producing children who will be either less damaged or diseased, or more healthy, or who will have enhanced capacities, violates the principle or equality. It does not. (3) Disability or impairment must be defined relative either to normalcy, "normal species functioning", or "species typical functioning". It is not necessarily so defined.     

早期乳腺癌内分泌治疗进展

乳腺癌是发生在乳腺腺上皮组织中的恶性肿瘤，其病因尚未完全清楚，可能与遗传及内分泌等因素相 关。针对激素受体阳性的早期乳腺癌，内分泌治疗疗效显著，且服用便捷，不良反应小，因此内分泌治疗在早期乳 腺癌治疗中占重要地位。但大部分患者在8~14个月后会发展为药物耐药，不得不寻求化学药物治疗或靶向治疗。目 前对于内分泌治疗药物与化学药物治疗或靶向药物联合用药的效果尚存在分歧，而且绝经前后用药亦有很大差异。     

降钙素原的临床应用进展

感染是临床上常见的病症,有效治疗的关键在于快速而准确地进行病原学诊断。降钙素原是降钙素的前体物质,作为一种炎性介质在细菌或真菌感染合并严重全身系统反应或器官低灌注时显著升高,而在病毒或局灶感染时水平正常或轻度升高,近年来成为鉴别细菌感染和其他病原体感染的新型标志物。现就其生物学特性、测量方法及临床应用予以综述。     

Gastroesophageal reflux: clinical presentations, diagnosis and management.

Symptomatic gastroesophageal reflux occurs daily in an estimated 7% of adults and weekly or monthly in 29%. Untreated it can lead to esophageal erosions, ulceration and stricture formation. The pathogenesis is often multifactorial: defects in the function of the lower esophageal sphincter, esophageal clearance mechanisms and gastric emptying combine to produce frequent lengthy periods during which the lower esophagus is bathed in regurgitated acid. In most patients reflux disease is easily recognized as recurrent heartburn, regurgitation or dysphagia, or a combination. When acute chest pain or respiratory illness is the primary presenting complaint the patient needs particularly careful investigation to determine whether the symptoms are due to a primary cardiac or respiratory condition, are secondary to gastroesophageal reflux alone or represent a combination of disorders. Endoscopy with biopsy and long-term pH monitoring are the most reliable ways of determining whether reflux disease is present. Additional investigations, such as exercise testing, cardiac catheterization or inhalation challenge, may be needed in patients with cardiac or respiratory symptoms. Treatment should follow a stepped-care approach and in most patients should begin with changes in lifestyle, including dietary manipulation, reducing alcohol and cigarette consumption, and raising the head of the bed, together with appropriate use of antacids or alginate-antacid combinations. H2-receptor antagonists and agents to improve both gastric emptying and the tone of the lower esophageal sphincter may be added in sequence. Most patients will respond well to this regimen. Surgery should be considered only for those with intractable symptoms or with complications (e.g., stricture formation, bleeding, development of dysplastic epithelium in those with Barrett's esophagus, or secondary pulmonary disease that does not respond to medical management). It is successful in 85% of well-selected patients and has few complications.     

SLIPA~(TM)通气道与普通喉罩及气管插管在腹腔镜妇科手术中的应用

目的 比较SLIPA~(TM)通气道与普通喉罩及气管插管3种气道管理方式在腹腔镜妇科手术时对患者血流动力学、呼吸参数变化和术后并发症发生率的影响,评估其在腹腔镜妇科手术中应用的安全性及优越性.方法 腹腔镜妇科手术患者90例,美国麻醉医师协会(ASA)Ⅰ～Ⅱ级,每组30例,随机分为3组.SLIPA~(TM)通气道组(S组)、普通喉罩组(L组)、气管插管组(T组).全麻诱导后分别置入SLIPA~(TM)通气道、普通喉罩、气管插管,记录心率、平均动脉压、气道吸气峰压、气道平台压、气道顺应性、气道阻力基础值及置人前后变化值;观察术中术后返流误吸、体动移位、口腔黏膜损伤、咳嗽咳痰、咽痛、声嘶情况,评估患者舒适度.结果 S组与L组血流动力学较T组稳定(P<0.05).置入通气道过程中,S组较L组、T组呼吸参数变化小(P<0.05),更为稳定.术中发生返流误吸、体动移位、口腔黏膜损伤较L组明显减少(P<0.05),术后咽痛、声嘶、咳嗽咳痰较L组与T组明显减少(P<0.05),患者在复苏过程中拔管舒适度更高P<0.05).结论 SLIPA~(TM)喉罩在腹腔镜妇科手术应用安全简便,对麻醉手术过程血流动力学,呼吸参数影响小,较普通喉罩、气管插管能明显减少术中术后并发症,提高患者舒适度,临床应用优越性更为明显.     

Superior vena cava syndrome. Clinical management.

Superior vena cava syndrome (SVCS) is an acute or subacute oncologic emergency with typical clinical features. The syndrome is almost invariably secondary to a malignant process. The treatment of choice is irradiation, but in resistant cases or in those instances in which radiation tolerance is achieved, either surgery or chemotherapy, or both, may play a crucial role. The major pitfalls in management relate to attempts to establish the site of obstruction and to obtain specific tissue diagnosis.     

EB病毒载量检测在相关疾病中标准化评价的进展

EB病毒属于人类疱疹病毒,与一些恶性肿瘤密切相关。EB病毒载量检测目前在临床中得到广泛应用,但是由于不同标本的类型、引物或探针、核酸的提取技术、使用的仪器、标准品和标准曲线、使用和报告的检测单位等影响,从而影响实验室间的比对。该文就这些影响EB病毒载量检测因素的标准化进行综述。     

老年人潜在不适当用药评价工具2019年版Beers标准解读

Beers标准是目前运用最广泛的老年人潜在不适当用药评价工具。2019-01-29,美国老年医学会（AGS）再次更新了该标准。本文对2019年版Beers标准进行解读,该标准沿用了2015年版的制定方法,保留了既往标准中的5种类型列表,但基于新的循证医学证据,增加、删除及修订了标准中的具体内容,其中包括30种老年人避免使用的药物/药物类别、40种在某些疾病或综合征下应避免应用或谨慎使用的药物及16项标准的重新梳理,如删除了已不在美国使用、较少使用或非老年人群特有的药物,补充了与跌倒或骨折、帕金森病或老年人失眠等疾病相关的避免使用药物及药物相互作用,对某些药物评价依据的描述更加具体和细化。2019年版Beers标准的基本框架和大体内容与2015年版Beers标准差异不大,但目标人群更为明确,内容更为精简,是保障老年人合理用药的有力工具。 老年人;给药系统,医院;潜在不适当用药;Beers标准,2019年版     

Role of doctors in prevention of torture

Torture is taking place since time immemorial. Doctors can take important part in elimination of this social evil. Torture is deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons to force another person or torture victim to make confession or giving information. Torture happens to occur in 3 forms--physical, mental and/or sexual. Doctors working in prisons, police or paramilitary/military forces are most likely to confront with torture and they should follow the medical ethics, codes and conventions in true sense. MCI, IMA, WMA should play their role in educating, motivating and supporting doctors in confronting torture. NHRC and IMA should co-operate each other to protect human rights.     

Selecting a treatment for primary varicose veins.

The treatment of varicose veins includes injection/compression sclerotherapy and surgical stripping or ligation or both. Surgery appears to be favoured when the saphenous system is involved or when the patient is 35 to 64 years old or presents with ankle edema or flare. On the other hand, sclerotherapy has been found to be more effective in patients with dilated superficial veins or incompetent perforating veins in the lower legs and to be more acceptable and less expensive than surgical treatment.