影响心肺脑复苏成功率的探讨

心跳骤停后,如何提高ＣＰＣＲ的成功率,一直是人们十分关注的问题。其中心肺复苏开始的时间是ＣＰＣＲ的关键。文献报道,ＣＡ后４ｍｉｎ内施行ＣＰＲ术,８－１０ｍｉｎ内得到全面抢救者,ＣＰＲ成功率可达４０％以上。本组８例,均为院内目周ＣＡ者,我们的ＣＰＲ成功率高达７５％,其中ＣＰＣＲ成功率为１２．５％。     

急诊145例心跳骤停与心肺脑复苏分析

目的 分析心跳骤停的临床特点及救治方法,提高急诊心肺脑复苏成功率.方法 回顾性分析我科2000年1月～2005年4月院前心跳骤停及治疗中心跳骤停的临床资料,分析治疗与预后的关系.结果 实施复苏的145例患者中,初步复苏22例,最终成活10例,分别为15%和7%;院前心跳停搏组复苏时间显著长于治疗中停搏组(P＜0.05);存活组复苏时间显著短于死亡组(P＜0.05).结论 心跳骤停复苏成功率与抢救开始时间、抢救措施等因素密切相关.     

早期心肺复苏失败原因分析及对策

目的　探讨早期心肺复苏失败的因素 ,提出提高心肺复苏成功率的相应对策。方法　对我院急诊室经抢救无效死亡、抢救记录完整的 6 6例病历进行原因分析。结果　早期心肺复苏失败主要与病因、院前急救不规范、CPR技术不标准以及急诊外科空白等有密切关系。结论　普及院前急救知识、提高院前急救人员的素质和技能、CPR技术标准化以及医院创建急诊外科是提高心肺复苏成功率的关键     

担架式心肺复苏机的临床应用及护理配合

2010版《心肺复苏指南》提出：为提高心肺复苏的有效性,使用机械按压装置应尽量减少对胸外按压的延误或中断。为此,使用者应该进行适当培训并做到熟练配合。我科自2009年以来,应用美国产蓝氏威克R-301心肺复苏机,按照我科自行制定的3人6步搬运程序,抢救了86例心跳骤停患者,现将护理配合工作的经验报告如下。     

老年患者术中心跳骤停复苏3例经验教训

心搏骤停是临床上极为紧急的状态,尤其老年人因器官功能减退加上并存疾病较多,故复苏困难。我院自2004年1月~5月,共发生3例老年患者术中完全心搏骤停,经抢救复苏成功,且未遗留任何并发症,现报告如下。1临床资料病例1,男,73岁,体重40 kg,因胃癌根治术后2年残胃再发癌,拟在全麻下行剖腹探查,胃癌根治术。术前血压(BP)120/70 mmHg,心率(HR)76次/min,SpO294%。无心肺脑疾患。因长期不能进食,营养状况极差。术前用药为阿托品0.5 mg肌注。麻醉诱导:静注咪达唑仑1.0 mg,芬太尼0.2mg,乙咪酯10 mg,维库溴铵4 mg,气管插管后控制呼吸,术中持续静滴0.…     

琥珀胆碱致室颤及心跳骤停并复苏成功1例

患者,男１９岁,战士。因剑突处反复流脓１年,１９９７．｜０１．｜３０入院。患者曾２次行胸壁结核病灶清除术。术前查体：体温、呼吸、脉搏、血压、心肺正常。专科情况,前胸壁见一窦道,挤压时见少许脓汁溢出。全血常规、出凝血时间、尿便常规、肝功能等项检查均正常...     

心跳呼吸骤停患者应用心肺复苏机与徒手心肺复苏疗效比较

《2010年国际心肺复苏及心血管急救指南》[1]调整了心肺复苏的流程,由A-B-C更改为C-A-B,把心脏按压放在了最重要的位置,指南再次强调了要保证持续按压,尽可能减少按压中断,不过早放弃患者。在临床实际操作过程中,由于医务人员的资源有限性和体力消耗等因素,同时越来越多患者家属对超长CRP的要求,     

目前心肺复苏研究的焦点

心跳骤停具有高发病率、高病死率和家属低接受率的特点,涉及到经济和社会的一系列问题,是危重病领域的一个重要课题。心肺复苏学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,经过40多年的研究,目前的研究焦点集中于复苏后细胞损伤机制、体外除颤的应用、亚低温疗法等方面。这些问题的深入研究将对提高心肺复苏成功率和患者生存质量起到积极的作用。     

院前心肺复苏100例临床分析

心跳骤停是临床上最紧急的危重症,是世界急诊医学中的难题,抢救不及时或抢救技术不准确都会导致失败。据报道即使发生在院内的心跳骤停患者的复苏成功率也仅为10%左右,而发生在院外的患者复苏成功率更低,仅为4%。现将我中心2008年院前复苏100例心跳骤停患者的资料进行临床分析,通过分析成败原因,以提高院前复苏成功率。     

医学影像存档与通信系统(PACS)的应用体会

目的介绍了胜利油田中心医院医学影像存档与通信系统(PACS)应用的体会。方法把具有医学数字成像及通信(digital imaging and communication in medicine)影像设备连接成医院的PACS系统；将传统的胶片存储模式与现代的PACS管理系统相比较。结果传统的胶片存储模式在影像和管理与存储上存在种种弊端，PACS系统实现了统一存储和资源共享。结论PACS的应用明显提高了放射科及相关科室的工作效率，方便了工作、教学、科研和会诊，提高了医院的社会效益和经济效益。     

经皮扩张气管切开术在重型颅脑损伤救治中的应用体会

探讨经皮扩张气管切开术在抢救102例重型颅脑损伤治疗中的应用效果,认为经皮扩张气管切开术在重型颅脑损伤抢救中是一种快捷、安全、有效的改善患者通气方法,值得临床推广.     

经鼻胃镜检查高龄患者458例体会

目的:评价经鼻胃镜检查在老年患者检查中的安全性和有效性.方法:通过经鼻胃镜检查观察患者的呼吸、心率、脉搏血氧饱和度变化情况及病人耐受性和疾病诊断情况.结果:所有患者呼吸、心率、脉搏血氧饱和度变化不大,患者耐受性好,疾病诊断满意.结论:经鼻胃镜检查在老年患者中是安全、有效的.     

湿润烧伤膏配合中草药外用治疗大面积烧伤病人静脉炎的体会

目的：探讨湿润烧伤膏配合中草药外用治疗大面积烧伤后静脉高营养引起的静脉炎的方法。方法：将53例发生静脉炎的大面积烧伤病人，创面全程应用烧伤皮肤再生医疗技术，配合中草药治疗，随即分为中草药外用治疗组(33例)和传统的50％硫酸镁、0．02％呋喃西林外用对照组(20例)进行对比观察。结果：治疗组临床总有效率96％，显效时间明显优于对照组。结论：湿润烧伤膏配合中草药外用治疗大面积烧伤后静脉高营养引起的静脉炎，安全可靠，无损伤，无毒副作用，显效快，疗效显著。     

休克病人行胃十二指肠动脉栓塞止血的体会

目的 :探讨动脉性上消化道出血的休克病人经导管栓塞止血治疗的临床应用价值。方法 :3例十二指肠球部出血伴休克的病人 ,腹腔动脉造影示腹腔动脉显影差 ,经导管注入利多卡因后 ,腹腔动脉造影见腹腔动脉显影好 ,胃十二指肠动脉造影剂外渗 ,用明胶海绵栓塞胃十二指肠动脉。结果 :3例病人术后上消化道出血症状消失 ,胃镜检查未见上消化道出血。结论 :对于上消化道出血的休克病人 ,如能明确出血的部位和准确地推断出血的血管 ,在积极治疗休克的情况下 ,采用适量的非离子型造影剂和血管扩张剂选择性地行血管造影 ,不仅能显示出血的血管 ,而且能对其进行栓塞止血治疗。     

末节断指吻合掌侧静脉的临床应用体会

手指末节离断伤30指经吻合掌侧静脉再植手术后,成活27指,坏死3指,术后患指功能及外观恢复均较满意.     

应用B超诊断450例输尿管结石的体会

我院1994—02～1999—05,应用B超诊断450例输尿管结石,经随访检查、体外碎石和手术治疗等证实,超声检查具有简便、无痛、无创伤等优点并优于X线检查。由于超声的探查面广,灵活、重复性强,大大提高了检出率和诊断准确性。现将我们的体会报告如下:1 临床资料1.1 一般资料 450例均为我院住院或门诊、急诊患者。其中男性231例,女性219例,除3例为双侧输尿管结石外,其余均为单侧     

湿润烧伤膏治疗糖尿病足30例临床体会

目的：观察湿润烧伤膏治疗糖尿病足的临床效果。方法：对30例糖尿病足外用湿润烧伤膏治疗，观察创面的变化及愈合方式。结果：24例糖尿病足自行愈合，3例既往拟定截肢的糖尿病足施行肉芽创面游离植皮而愈合，另3例截肢。结论：糖尿病足采用湿润烧伤膏治疗，方法简单，实用性强，效果满意。     

CTP in Transient Global Amnesia: A Single-Center Experience of 30 Patients

BACKGROUND AND PURPOSE:Medial temporal lobe abnormalities on DWI and functional imaging are occasionally observed in patients with transient global amnesia. We used CTP to study these patients during or briefly after resolution of their amnesic syndrome.MATERIALS AND METHODS:From 2002 onward, patients satisfying clinical criteria for transient global amnesia who underwent CTP were included. Patients with additional clinical features suggesting transient ischemic attack or stroke and those with an ischemic lesion on subsequent DWI were excluded. If deemed necessary by the clinician, DWI was performed within 10 days.RESULTS:Thirty patients with transient global amnesia underwent CTP at a median latency of 5.9 hours (interquartile range, 4.3–9.7 hours) after symptom onset. All findings, except for those in 1 patient, were normal, including those in the 14 patients with well-imaged hippocampi. In the patient with abnormal findings, CTP and PWI showed hypoperfusion in both lentiform nuclei extending into the insulae, with normalization on the repeat CTP 6 days later. In 10 patients, DWI was performed at a median latency of 2 days (interquartile range, 0–9 days). Of these, 2 showed punctate hippocampal lesions, often seen in transient global amnesia. In 2 patients excluded because of mildly atypical transient global amnesia and ischemic lesions on subsequent DWI, acute CTP findings were also normal.CONCLUSIONS:Patients with transient global amnesia had normal CTP findings in the acute phase with the exception of 1 patient with transient hypoperfusion in both basal ganglia. If imaging is performed for typical and atypical transient global amnesia, DWI should be the preferred method.

Transient global amnesia (TGA) is characterized by the sudden onset of antero- and retrograde amnesia that is often triggered by an acute emotional or physical event and spontaneously resolves within 24 hours. Repetitive questioning and anxiety are often present, but other focal neurologic disturbances are usually absent.^1,2Functional brain imaging with SPECT and PET shows local disturbances in regional blood flow (usually hypoperfusion, rarely hyperperfusion) and in oxygen/glucose metabolism, most frequently in 1 or both medial temporal lobes.^3–5 Punctate signal hyperintensities appearing in 1 or both hippocampi on DWI were first described by Matsui et al⁶ in a classic TGA case in 2002 and then more systematically by Sedlaczek et al.⁷ Although the specific sites of impairment have been identified, the underlying etiology of TGA remains elusive.²Images in a case series of patients with TGA who underwent PWI within 24 hours of symptom onset showed unilateral perfusion abnormalities in 4 of the 28 patients (1 in the anterior, 1 in the posterior, and 2 in the middle cerebral artery territory).⁸ However, the authors did not specify whether structures relevant for memory were involved.CTP is widely used for the early diagnosis of acute ischemic stroke and TIA, though its true value remains to be established by appropriate research.⁹ To our knowledge, results using CTP for acute TGA diagnosis have not been published. We, therefore, aimed to determine the frequency and localization of perfusion abnormalities in patients with acute TGA by using CTP to investigate its potential diagnostic value and to better elucidate the pathogenesis of this disorder.     

Experience of application of intellectual computer technologies in the treatment-and-diagnostic practice

To improve the screening system, the early pre-clinical diagnosis, the choice of therapeutic tactics and medicaments for treating some diseases about 1800 patients were investigated with the use of up-to-date technologies. The new method allows the physicians optimizing the process of decision making and improving the significant element of demonstration medicine, i.e. the transformation of investigational results into argumentative practical recommendations. The method's precision reached 93%.