氨茶碱联用大剂量肾上腺素对老年人心肺复苏的影响

目的 探讨氨茶碱联用大剂量肾上腺素对老年人心肺复苏的影响.方法 选择老年心搏骤停患者126例,随机分为A组40例、B组43例、C组43例,分别给予肾上腺素1 mg、肾上腺素5 mg、氨茶碱0.5g+肾上腺素5mg静脉推注.观察各组临床疗效、股动脉压和血浆TNF-α、IL-6浓度变化.结果 与A组、B组比较,C组自主循环恢复率、24 h存活率明显增高,自主循环持续时间明显延长,自主循环和自主呼吸恢复时间明显缩短,主动脉舒张压明显增高,血浆TNF-α、IL-6浓度明显降低,以上差异均有统计学意义(P均＜0.05).结论 心肺复苏早期氨茶碱联用大剂量肾上腺素能促进自主循环和自主呼吸的恢复与稳定.     

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。     

心肺脑复苏中联合应用肾上腺素、血管加压素、纳洛酮效果观察

目的评价心肺脑复苏中联合应用肾上腺素、血管加压素和纳洛酮的疗效。方法将57例心跳骤停患者随机分为两组，均常规行心肺脑复苏。在此基础上治疗组联合应用肾上腺素、血管加压素、纳洛酮，对照组仅予标准剂量肾上腺素治疗。结果与对照组比较，治疗组总有效率明显升高（P〈0．05），自主循环恢复时间明显缩短（P〈0．01）。结论联合应用肾上腺素、血管加压素、纳洛酮可提高心肺脑复苏成功率。     

心肺复苏机抢救心脏骤停的应用及有效性分析

目的:观察急诊室心肺复苏机抢救心脏骤停的应用及有效性。方法:106例心脏骤停患者,随机分为2组,各53例,对照组行徒手心肺复苏治疗,研究组行心肺复苏机治疗,比较2组心肺复苏前、后动脉血气指标[二氧化碳分压(PaCO_2)、氧分压(PaO_2)、血氧饱和度(SaO_2)]水平、心功能指标[羟丁酸脱氢酶(HBDH)、天门冬氨酸转氨酶线粒体同工酶(m-AST)、肌酸激酶同工酶(CK-MB)]、自主呼吸及自主循环恢复时间、心肺复苏有效率与成功率、并发症。结果:心肺复苏前,2组动脉血气指标水平比较无差异(P0.05);心肺复苏后,研究组PaO_2、SaO_2高于对照组,PaCO_2低于对照组,差异均有统计学意义(均P0.05);心肺复苏前,2组心功能指标比较无差异(P0.05);心肺复苏后,研究组HBDH、m-AST、CK-MB低于对照组(均P0.05);研究组自主呼吸恢复时间、自主循环恢复时间优于对照组(均P0.05);研究组心肺复苏有效率、成功率高于对照组(均P0.05);研究组并发症发生率低于对照组(P0.05)。结论:心脏骤停患者应用心肺复苏机的临床效果值得肯定,抢救成功率高。     

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。     

心肺复苏中血流动力学机制实验及应用研究进展

心肺复苏（cardiopulmonary resuscitation,CPR）指对于早期心脏呼吸骤停的患者,通过采取人工呼吸、人工循环、电除颤等方法帮助患者恢复自主呼吸和自主心跳的一种急救技术。     

垂体后叶素联合氨茶碱对老年心肺复苏病人的效果观察

目的探讨垂体后叶素联合氨茶碱对老年呼吸、心搏骤停病人心肺复苏的效果。方法选择2016年1月至2017年6月在我院接受治疗的心搏、呼吸骤停老年病人86例,根据药物使用的不同随机分为单独氨茶碱治疗组(常规组)44例和垂体后叶素联合氨茶碱治疗组(研究组)42例。收集并记录2组病人的临床基本资料,并对2组病人用药后的临床疗效及心肺复苏的预后进行比较。结果心脑血管类疾病是导致病人心搏、呼吸骤停的主要原因。研究组病人48 h存活率和出院后存活率均明显高于常规组,呼吸及循环系统恢复所用的时间均低于常规组,差异有统计学意义(P0.05);2组病人复苏后的血压差异无统计学意义(P0.05);研究组病人的心率、动脉血压、6 h尿量均明显优于常规组,差异有统计学意义(P0.05)。结论垂体后叶素联合氨茶碱对老年呼吸、心搏骤停病人的心肺复苏有明显疗效,可提高老年病人的存活率并改善病人预后,值得临床推广和应用。     

氨茶碱与肾上腺素合用在大鼠心脏停搏中的疗效

目的　探讨氨茶碱与肾上腺素合用在大鼠窒息致心脏停搏中的疗效是否优于单纯使用肾上腺素或氨茶碱。方法　采用呼气末夹闭气管 8min ,建立大鼠窒息致心脏停搏模型。 36只大鼠随机分为氨茶碱 ( 10mg kg) +肾上腺素 ( 0 .0 2mg kg)组、肾上腺素 ( 0 .0 2mg kg)组和氨茶碱 ( 10mg kg)组 ,分别行心肺复苏 ,比较 3组大鼠的心脏电活动和自主循环恢复情况以及存活率。结果　心电活动恢复率 3组无显著性差异。起效时间氨茶碱 +肾上腺素组为( 4 3.0± 34.0 )s,氨茶碱组为 ( 39.0± 2 3.0 )s ,两组显著快于肾上腺素组 ( 90 .0± 4 2 .0 )s。自主循环恢复率 3组无显著性差异。自主循环恢复大鼠的平均血压氨茶碱 +肾上腺素组为 ( 5 5 .5± 17.3)mmHg( 1mmHg =0 .133kPa) ,显著高于肾上腺素组 ( 2 6 .7± 7.8)mmHg和氨茶碱组 ( 15 .0± 2 .4 )mmHg。 1h存活率 3组无显著性差异。结论　氨茶碱和肾上腺素合用在窒息致心脏停搏大鼠模型中 ,对自主循环血压的恢复优于单纯使用肾上腺素或氨茶碱     

观察心肺复苏按压指导仪在院前急救中的应用效果

目的观察心肺复苏按压指导仪在院前急救中的应用效果。方法选取我院2014年3月~2015年3月收治的心脏骤停患者113例,分为研究组与对照组。研究组患者院前急救使用心肺复苏按压指导仪;对照组使用人工按压心肺复苏。比较观察两组患者心肺复苏时间及自主呼吸恢复时间,心肺复苏成功率、血压。结果与对照组相比,研究组患者心肺复苏时间、自主呼吸时间均较短,组间比较,差异有统计学意义(P0.05);研究组与对照组存活时间24 h的患者分别为33.3%(19/57)、16.1%(9/56),组间比较,有统计学意义(P0.05);两组康复出院的患者构成比分别为28.1%(16/57)、8.9%(5/56),差异有统计学意义(P0.05);急救后,研究组与对照组收缩压分别为(93.5±2.3)mm Hg、(75.6±1.9)mm Hg,舒张压(63.5±2.4)mm Hg、(50.6±2.1)mm Hg,差异有统计学意义(P0.05)。结论与人工心肺复苏相比,心肺复苏按压指导仪更加贴合患者呼吸、心跳节律,可缩短心肺复苏时间、自主呼吸时间,提高复苏成功率,为患者后续治疗提供了更多机会,值得临床推广使用。     

影响诊心肺复苏成功的因素调查

对174例心跳呼吸骤停实施心肺复苏者进行回顾性分析。结果影响心肺复苏成功与复苏时机的早晚和规范化有很大的相关性;性别、年龄与心肺复苏成败无明显关系（P〉0.05）;心跳呼吸骤停者低钾血症发生率明显高于正常。女性复苏后存活时间较男性长（P〈0.01）。认为及时有效的规范化心肺复苏术、及早纠正低钾倾向是心肺复苏成功的关键;复苏成功后患者及时清醒和低血压改善直接影响脑复苏效果。     

Aminophylline fails to improve the outcome of cardiopulmonary resuscitation from prolonged ventricular fibrillation: A placebo-controlled,randomized, blinded experimental study

Objectives. The purpose of this study was to evaluate systematically the effects of the adenosine antagonist aminophylline on resuscitation outcome In a canine model of postcardioversion nonperfusing rhythm.Background. Theoretic considerations and experimental studies indicate that myocardial adenosine accumulation during prologged ventricular fibrillation might play a significant role in postcardioversion asystole and electromechanical dissociation. A recent uncontrolled clinical trial has suggested that the adenosine antagonist aminophylline might improve the outcome of cardiopulmonary resuscitation from refractory bradyasystolic cardiac arrest.Methods. Two placebo-controlled, randomized, blinded experimental studies were performed. In protocol 1 (20 dogs), ventricular fibrillation was induced and maintained for 7.5 min. Sixty seconds before cardioversion, dogs received 1 mg of epinephrine followed by 250 mg of aminophylline or placebo. In protocol 2 (20 dogs), dogs were cardioverted to electromechanical dissociation after 5 min of unsupported ventricular fibrillation. Sixty seconds later, all dogs received 1 mg of epinephrine followed by 250 mg of aminophylline or placebo. In both experiments, resuscitation efforts were continued until return of spontaneous circulation, or up to 30 min. The primary end point was survival to 1 h.Results. In protocol 1, 4 of 10 dogs survived in the aminophylline group, whereas 7 of 10 dogs survived in the placebo group, a nonsignificant trend toward unfavorable outcome from aminophylline. Pretreatment with aminophylline increased the number of cardioversion applications required to terminate ventricular fibrillation. In protocol 2, 5 of 10 and 6 of 10 dogs survived in the aminophylline and placebo groups, respectively.Conclusions. The results of this study suggest that aminophylline fails to improve the outcome of resuscitation from prolonged ventricular fibrillation. It does not reverse established electronic-chemical dissection and may in fact increase the number of cardioversion applications required to terminate ventricular fibrillation. The rationale for conducting clinical trials with aminophylline during cardiopulmonary resuscitation is questionable.     

甲泼尼龙琥珀酸钠对窒息型大鼠复苏后早期的心功能影响

目的:探讨甲泼尼龙琥珀酸钠(甲强龙)对窒息大鼠模型心肺复苏后早期心功能的影响及机制。方法:45只SD大鼠,雌雄不拘,分为对照组、常规复苏组(常规复苏+肾上腺素10μg/kg)和甲强龙组(常规复苏+肾上腺素10μg/kg+甲强龙1.8 mg/kg)。对窒息大鼠模型进行心肺复苏,记录平均动脉压(MAP)、左心室收缩压(LVSP)和左心室舒张末压(LVEDP)的变化,ELISA法检测大鼠心脏组织中肾上腺素能α1受体和β1受体水平。结果:在心肺复苏自主循环恢复(ROSC)30 min后,与对照组比较,常规复苏组及甲强龙组大鼠的MAP和LVSP均有明显下降(P均0.05);在ROSE后0、15 min时,常规复苏组及甲强龙组LVEDP与对照组相比有显著性差异(P均0.05)。甲强龙组MAP在ROSC后60、120 min时,LVSP在ROSC后30、60、120 min时均显著高于常规复苏组(P均0.05)。心肺复苏后,甲强龙组与对照组、常规复苏组比较,心脏组织中肾上腺素能α1受体和β1受体水平均明显升高(P均0.05)。结论:甲强龙可提高心肺复苏后心脏组织内肾上腺素能α1受体和β1受体含量,有利于心肺复苏后MAP和LVSP的稳定。     

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.     

心肺复苏成功率与除颤时间窗关系的临床分析

目的:探讨心肺复苏成功率与除颤时间窗的关系及临床意义。方法:对86 例各种原因导致的心脏骤停患者在心肺复苏中及早使用电除颤时间窗与复苏成功率的相关性进行观察分析。结果:发现在心肺复苏中恢复自主呼吸与循环的44 例心脏骤停患者中尽早使用电除颤与复苏成功率有着密切的相关性,除颤开始的时间距心脏骤停发作越短复苏成功率越高。结论:心脏骤停患者尽早实施电除颤可明显提高心肺复苏成功率。     

Usefulness of vasopressin administered with epinephrine during out-of-hospital cardiac arrest

Vasopressin administration has been suggested during cardiopulmonary resuscitation, and a previous clinical trial has suggested that vasopressin is most effective when administered with epinephrine. Adult subjects (n = 325) who received > or =1 dose of intravenous epinephrine during cardiopulmonary resuscitation for nontraumatic, out-of-hospital cardiac arrest were randomly assigned to receive 40 IU of vasopressin (n = 167) or placebo (n = 158) as soon as possible after the first dose of epinephrine. The rate of return of pulses was similar between the vasopressin and placebo groups (31% vs 30%), as was the presence of pulses at the emergency department (19% vs 23%). No subgroup appeared to be differentially affected, and no effect of vasopressin was evident after adjustment for other clinical variables. Additional open-label vasopressin was administered by a physician after the study drug for 19 subjects in the placebo group and 27 subjects in the vasopressin group. Results were similar if these subjects were excluded or were assigned to an actual drug received. Survival duration for subjects admitted to the hospital did not differ between groups. In conclusion, vasopressin administered with epinephrine does not increase the rate of return of spontaneous circulation.     

Pre-Hospital Administration of Epinephrine in Pediatric Patients With Out-of-Hospital Cardiac Arrest

BackgroundThere is little evidence about pre-hospital advanced life support including epinephrine administration for pediatric out-of-hospital cardiac arrests (OHCAs).ObjectivesThis study aimed to assess the effect of pre-hospital epinephrine administration by emergency-medical-service (EMS) personnel for pediatric OHCA.MethodsThis nationwide population-based observational study in Japan enrolled pediatric patients age 8 to 17 years with OHCA between January 2007 and December 2016. Patients were sequentially matched with or without epinephrine during cardiac arrest using a risk-set matching based on time-dependent propensity score (probability of receiving epinephrine) calculated at each minute after initiation of cardiopulmonary resuscitation by EMS personnel. The primary endpoint was 1-month survival. Secondary endpoints were 1-month survival with favorable neurological outcome, defined as the cerebral performance category scale of 1 or 2, and pre-hospital return of spontaneous circulation (ROSC).ResultsDuring the study period, a total of 1,214,658 OHCA patients were registered, and 3,961 pediatric OHCAs were eligible for analyses. Of these, 306 (7.7%) patients received epinephrine and 3,655 (92.3%) did not receive epinephrine. After time-dependent propensity score-sequential matching, 608 patients were included in the matched cohort. In the matched cohort, there were no significant differences between the epinephrine and no epinephrine groups in 1-month survival (epinephrine: 10.2% [31 of 304] vs. no epinephrine: 7.9% [24 of 304]; risk ratio [RR]: 1.13 [95% confidence interval (CI): 0.67 to 1.93]) and favorable neurological outcome (epinephrine: 3.6% [11 of 304] vs. no epinephrine: 2.6% [8 of 304]; RR: 1.56 [95% CI: 0.61 to 3.96]), whereas the epinephrine group had a higher likelihood of achieving pre-hospital ROSC (epinephrine: 11.2% [34 of 304] vs. no epinephrine: 3.3% [10 of 304]; RR: 3.17 [95% CI: 1.54 to 6.54]).ConclusionsIn this study, pre-hospital epinephrine administration was associated with ROSC, whereas there were no significant differences in 1-month survival and favorable neurological outcome between those with and without epinephrine.     

急诊科老年人心肺复苏的特点分析

在我院急诊科进行心肺复苏的非创伤患者中,老年人约占45.21%(33/73),由于生理功能的衰退导致他们往往合并有多种慢性疾病,老年患者的心肺复苏有其自身的一些特点,本文对这些特点进行了分析和总结。1资料与方法1.1病例资料本次病例资料为2001年1月至2006年1月发生在急诊科的非创     

Comparison of standard versus high-dose epinephrine in the resuscitation of cardiac arrest in dogs

A prospective, randomized, blinded study was conducted to evaluate the efficacy of standard compared with high-dose epinephrine in cardiac arrest in dogs. Twenty-five mongrel dogs were anesthetized and monitored by central venous catheter, intra-arterial catheter, and ECG. A left lateral thoracotomy was performed, and the proximal left anterior descending artery was ligated. After ten minutes of myocardial ischemia, ventricular fibrillation was obtained by application of 6-V AC. Mechanical ventilation was stopped. Total arrest time was ten minutes. All animals were randomized into one of five resuscitation protocols; each protocol was identical except for the dose and route of epinephrine administration. Group 1 animals comprised the control group and received normal saline. Group 2 and 3 animals received epinephrine in doses of 0.014 mg/kg by central venous and intracardiac injection, respectively. Group 4 and 5 animals received epinephrine in doses of 0.071 mg/kg by central venous and intracardiac injection, respectively. None of the dogs receiving normal saline had a return of spontaneous circulation, defined as a spontaneous systolic blood pressure of more than 50 mm Hg. Nine of the ten animals from groups 2 and 3 and all of the ten animals from groups 4 and 5 had a return of spontaneous circulation. However, animals receiving the standard dose of epinephrine had a significantly longer resuscitation time compared with the high-dose group (P = .05) and required more doses of epinephrine for successful resuscitation than did animals receiving high doses (P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)     

心肺复苏早期应用大剂量肾上腺素的临床研究

探讨了心肺复苏（ＣＰＲ）早期应用大剂量肾上腺素（ＨＤＦ）对动脉压及临床效果的影响。将６２例心骤停（ＣＡ）患者根据ＨＤＦ用法分为早期组和非早期组进行抢救，于肾上腺素（Ｅ）首剂量后对两组各５例患者行动脉压测定。结果显示，ＣＰＲ成功率、出院存活率、主动脉舒张压和收缩压早期组明显高于非早期组（Ｐ〈０．０１，Ｐ〈０．０５）。证明早期应用ＨＤＦ具有临床价值。