126例心跳骤停心肺复苏临床分析

目的：探讨急诊抢救心跳骤停的程序及方法，以便提高心肺复苏成功率。方法：回顾性分析126例在急诊抢救心跳骤停患者的临床资料，分析抢救程序及方法对心肺复苏的影响。结果：126例患者中31例复苏成功，63例复苏有效，32例复苏无效。结论：心肺复苏抢救成功与开始抢救时间、胸外按压方法、抢救药物及仪器的合理应用有密切关系。     

1例5d内3次心跳骤停心肺脑复苏成功的护理

任何心脏病患者或非心脏病患者，在未能估计到的时间内，心搏突然停止，即应视为心脏骤停。心脏骤停的抢救是一场挽救生命的紧张战斗，因为心脏停搏3～5min以上，中枢神经系统因缺氧过久而造成严重的损害往往是不可逆的。我院东病区于2000年1月收治1例以反复活动后胸闷、心前区不适3个月，拟冠心病、心绞痛收入院。     

16例心跳呼吸骤停心肺复苏临床分析

１６例心跳呼吸骤停心肺复苏临床分析湖南省新田县人民医院莫述仁本文就１６例心跳呼吸骤停复苏情况进行分析。１．临床资料１．１一般临床资料１６例中男９例，女７例。年龄最大６０岁，最小３岁，平均３８岁。发生地点，医院急诊室９例，病房３例，院外２例，心跳呼吸骤...     

电击伤致心跳骤停18例的抢救探讨

目的：探讨18例电击伤致心跳骤停的抢救体会。方法18例均进行心肺复苏术(CPR)，在复苏的同时进行脑复苏，及时处理心肺的并发症。结果18例病人中抢救成功12例，死亡6例。结论现场CPR与预后关系密切。早插管、早除颤、早期开展脑复苏可提高CPCR的成功率。     

50例心跳呼吸骤停病人心肺复苏的分析

目的：探讨心跳呼吸骤停病人抢救的临床经验，提高心肺复苏的成功率。方法：回顾性分析我院2006-2007年急诊抢救的50例心跳呼吸骤停病人的临床资料，通过分析影响心肺复苏的因素以提高心肺复苏的成功率。结果：50例中初步心肺复苏的12例，最终康复出院的6例。结论：心肺复苏的成功率与该患者的原发病，心跳呼吸骤停时间，CPR的及时正确，电除颤的及时准确使用，及早气管插管以及脑复苏的正确及时实施有相关性。另外碳酸氢钠及大剂量的肾上腺素使用可提高成功率。     

1例5 d内3次心跳骤停心肺脑复苏成功的护理

任何心脏病患者或非心脏病患者,在未能估计到的时间内,心搏突然停止,即应视为心脏骤停[1].心脏骤停的抢救是一场挽救生命的紧张战斗,因为心脏停搏3～5 min以上,中枢神经系统因缺氧过久而造成严重的损害往往是不可逆的.我院东病区于2000年1月收治1例以反复活动后胸闷、心前区不适3个月,拟冠心病、心绞痛收入院.     

心跳呼吸骤停心肺复苏112例临床分析

心跳呼吸骤停是临床上最紧急的危重症,在急诊科尤为常见,如不及时采取正确有效的急救措施,可迅速出现不可逆性脑死亡。2000年4月至2006年4月我部共抢救心跳呼吸骤停患112例,心肺复苏成功20例,脑复苏成功7例,现总结报告如下。[第一段]     

心肺脑复苏的护理进展

心肺脑复苏(CPCR)护理是抢救心跳、呼吸骤停及保护、恢复大脑功能的急救护理技术。急诊护理人员必须熟练掌握心肺复苏技能，明确护士在心肺脑复苏中的角色，及时了解心肺脑复苏的新动态，帮助护士在心肺复苏过程中及时准确地预见可能出现的问题，以最有效的方式进行复苏，提高临床抢救成功率。     

Bacteremia following cardiac arrest and cardiopulmonary resuscitation

After but of hospital CPR thirty three resuscitated patients were studied for bacteremic complications. Thirteen patients (39%) had two or more positive blood cultures during the twelve hours following CPR. Source of superinfection was a central venous catheter in one case (staphylococcus). The twelve other bacteremic patients had fetid diarrhea a few hours after admission. The same organism were found in blood and faeces (streptococcus D, Escherichia coli, Pseudomonas aeruginosa, acinetobacter, enterobacter). Mesenteric ischemia caused by a low cardiac output may explain the diarrhea and the intestinal origin of the septicemia. All patients (12 cases) with diarrhoea and bacteremia died. Patients who recovered without neurologic sequelae (4 cases) had never been septic and never had diarrhea.     

插入式腹主动脉按压对心搏骤停兔心肺脑复苏的实验研究

目的：探讨插入式腹主动脉按压心肺复苏（IAAC-CPR）对心搏骤停兔心肺脑复苏的效果。方法健康新西兰大白兔10只,雌雄不拘,按随机数字表法分为传统胸外按压心肺复苏（CC-CPR）组和IAAC-CPR组,每组5只。经颈静脉快速推注冰氯化钾并夹闭气管导管制备心搏骤停模型;心搏骤停3 min后开始实施心肺复苏（CPR）,CC-CPR组为呼吸机辅助通气+胸外按压;IAAC-CPR组为呼吸机辅助通气+胸外按压+腹主动脉按压。观察CPR过程中血流动力学和脑皮质血流的变化;记录自主循环恢复（ROSC）时间,观察动物24 h生存情况、24 h神经功能评分及腹部器官情况等。结果 IAAC-CPR组复苏后30、60、90、120 s时脑血流量（CBF,PU值）及平均动脉压（MAP,mmHg,1 mmHg＝0.133 kPa）均明显高于CC-CPR组（CBF 30 s：16.1±6.0比7.8±2.2,60 s：91.6±11.8比57.3±23.2,90 s：259.9±74.9比163.6±50.3,120 s：301.5±60.5比208.4±23.8;MAP 30 s：46.4±9.4比31.4±8.7,60 s：55.8±13.8比34.0±11.5,90 s：61.2±11.5比38.2±10.1,120 s：63.6±11.8比40.2±10.2;均P＜0.05）。与CC-CPR组比较,IAAC-CPR组ROSC所需时间明显缩短（s：182.0±59.0比312.6±86.6,t＝2.787,P＝0.024）,24 h神经功能评分明显下降（分：2.4±1.7比4.6±0.6,t＝2.974,P＝0.023）;而复苏成功率（80.0%比60.0%,χ2＝0.000,P＝1.000）、24 h存活率升高（80.0%比40.0%,χ2＝0.417,P＝0.519）,但差异无统计学意义。ROSC后24 h尸解动物均未发现肝脏损伤。结论在心搏骤停兔复苏早期,IAAC-CPR较CC-CPR取得了更好的脑血流灌注,明显减轻了心搏骤停兔的神经系统功能损伤,且无腹部器官损伤。     

Eleven years of experience with extracorporeal cardiopulmonary resuscitation for paediatric patients with in-hospital cardiac arrest

Purpose

The study aims to describe 11 years of experience with extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital paediatric cardiac arrest in a university affiliated tertiary care hospital.

Methods

Paediatric patients who received extracorporeal membrane oxygenation (ECMO) during active extracorporeal cardiopulmonary resuscitation (ECPR) at our centre from 1999 to 2009 were included in this retrospective study. The results from three different cohorts (1999–2001, 2002–2005 and 2006–2009) were compared. Survival rates and neurological outcomes were analysed. Favourable neurological outcome was defined as paediatric cerebral performance categories (PCPC) 1, 2 and 3.

Results

We identified 54 ECPR events. The survival rate to hospital discharge was 46% (25/54), and 21 (84%) of the survivors had favourable neurological outcomes.The duration of CPR was 39 ± 17 min in the survivors and 52 ± 45 min in the non-survivors (p = NS). The patients with pure cardiac causes of cardiac arrest had a survival rate similar to patients with non-cardiac causes (47% (18/38) vs. 44% (7/16), p = NS).The non-survivors had higher serum lactate levels prior to ECPR (13.4 ± 6.4 vs. 8.8 ± 5.1 mmol/L, p < 0.01) and more renal failure after ECPR (66% (19/29) vs. 20% (5/25), p < 0.01).The patients resuscitated between 2006 and 2009 had shorter durations of CPR (34 ± 13 vs. 78 ± 76 min, p = 0.032) and higher rates of survival (55% (16/29) vs. 0% (0/8), p = 0.017) than those resuscitated between 1999 and 2002.

Conclusions

In our single-centre experience with ECPR for paediatric in-hospital cardiac arrest, the duration of CPR has become shorter and outcomes have improved in recent years. Higher pre-ECPR lactate levels and the presence of post-ECPR renal failure were associated with increased mortality. The presence of non-cardiac causes of cardiac arrest did not preclude successful ECPR outcomes. The duration of CPR was not significantly associated with poor outcomes in this study.     

体外膜肺氧合在心肺脑复苏中的应用

目的 探讨体外膜肺氧合(extlacorporeal membrane oxygenation,ECMO)在心脏骤停患者中的治疗作用及应用价值.方法 回顾分析2002年6月至2007年6月期间,本院急诊和重症监护室应用体外膜肺氧合(ECMO)治疗的心脏骤停15例患者,按照美国心脏学会<2005年心肺复苏和心血管急救国际指南>的标准诊治方案进行救治,同时行体外膜肺氧合(ECMO)治疗.采用治疗前后自身对照的方法,监测ECMO治疗前、ECMO治疗后10 min、1 h、6 h、12 h、24 h,患者的心率、平均动脉压、中心静脉压(eve);并抽取桡动脉血检测动脉血氧分压、二氧化碳分压、血氧饱和度、酸碱度、动脉血乳酸含量等指标;统计数据以((x)±s)表示,采用SPSS 10.0统计软件包进行t检验,以P<0.05为差异具有统计学意义;同时就患者的神经性后遗症进行了观察和描述.结果 平均动脉压在ECMO治疗后10min比ECMO治疗前明显升高(P<0.01),ECMO治疗后1 h比ECMO治疗后10 min有所升高(P<0.05);CVP在ECMO治疗后10 min比ECMO治疗前,ECMO治疗后1 h比ECMO治疗后10 min有所降低(P<0.05);经ECMO治疗后10 min动脉血氧分压、血氧饱和度较ECMO治疗前明显上升(P<0.01),pH明显升高(P<0.01),动脉血乳酸含量明显降低(P<0.01).15例患者中,11例康复出院,其中5例完全康复,没有后遗症,2例有部分记忆障碍,无躯体后遗症;2例有精神障碍,2例有肢体偏瘫.结论 ECMO治疗可辅助心脏维持有效的血液循环,明显改善低氧血症,为大脑提供稳定的氧合血灌流,对心肺脑复苏有利.     

Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A review of the Japanese literature

Aim

Although favourable outcomes in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest have been frequently reported in Japanese journals since the late 1980s, there has been no meta-analysis of ECPR in Japan. This study reviewed and analysed all previous studies in Japan to clarify the survival rate of patients receiving ECPR.

Material and methods

Case reports, case series and abstracts of scientific meetings of ECPR for out-of-hospital cardiac arrest written in Japanese between 1983 and 2008 were collected. The characteristics and outcomes of patients were investigated, and the influence of publication bias of the case-series studies was examined by the funnel-plot method.

Results

There were 1282 out-of-hospital cardiac arrest patients, who received ECPR in 105 reports during the period. The survival rate at discharge given for 516 cases was 26.7 ± 1.4%. The funnel plot presented the relationship between the number of cases of each report and the survival rate at discharge as the reverse-funnel type that centred on the average survival rate. In-depth review of 139 cases found that the rates of good recovery, mild disability, severe disability, vegetative state, death at hospital discharge and non-recorded in all cases were 48.2%, 2.9%, 2.2%, 2.9%, 37.4% and 6.4%, respectively.

Conclusions

Based on the results of previous reports with low publication bias in Japan, ECPR appears to provide a higher survival rate with excellent neurological outcome in patients with out-of-hospital cardiac arrest.     

255例院前心搏骤停患者心肺复苏影响因素分析

目的了解6年来心肺复苏(CPR)现状,分析其影响因素,研究如何提高CPR水平。方法对本院2001-01～2007-01院前发生的255例心搏骤停(cardiacarrest,CA)患者的资料进行分析,比较自主循环恢复(ROSC)成功组和失败组的CPR开始时间、CPR持续时间、除颤次数、肾上腺素用量等。结果全部病例ROSC成功率为38.03%,脑复苏成功率仅为2.74%。两组CPR开始时间(从心脏停搏至CPR开始时间)、人工气道开始建立时间、是否安装临时起搏器、肾上腺素用量比较差异有统计学意义(P≤0.01),在CPR持续时间、除颤次数方面比较差异无统计学意义(P>0.05)。CPR成功率与CPR开始时间和急救水平高低有密切关系。结论CA患者CPR成功率较低,与"生命链"未彻底落实及急救水平低有关。普及全民急救知识,加强完善急救医疗体系建设,是提高CPR成功率的关键措施。     

心肺复苏质量对心博骤停猪血流动力学及氧代谢的影响

目的 应用O-CPR技术控制心肺复苏(CPR)质量,以观察在心脏骤停动物模型实施不同质量的CPR对复苏期间血流动力学和氧代谢的影响.方法 18头体质量为(30±1)kg的北京长白猪麻醉后,右侧股静脉送入Swan-Ganz导管并连接爱德华VigianceⅡ连续心排血量监测仪,左侧颈内静脉置管并放置电极到右心室,并分别行主动脉、右心房置管,连续记录血流动力学各指标,然后使用医用程控刺激仪电击致动物心博骤停,在室颤4 min后,将实验猪随机分为2组,标准CPR组和不标准CPR组,利用飞利浦HeartStart MRx监护仪/除颤器的O-CPR进行质量控制,监测胸外按压的深度、频率和回弹等.其中标准CPR组在复苏时进行标准胸外按压,频率为100次/min,按压通气比为30:2,按压深度为38～51 mm,胸廓充分回弹;不标准CPR组按压频率和按压通气比不变,但是按压深度为标准按压的60%～70%,每次胸廓回弹均不完全.在按压和通气9 min后开始电除颤.在各个时间点监测心排血量(CO)、平均主动脉压(MAP)等,计算冠脉灌注压(CPP),监测动静脉血气并计算氧输送量(DO2)和氧耗量(VO2)等,记录复苏成功的实验猪头数.数据处理采用SPSS 11.5统计软件进行y2检验和两个样本的t检验.结果 标准CPR组的自主循环恢复(ROSC)的成功率达90.9%,明显高于不标准者的28.6%(P=0.013),标准CPR组主要血流动力学指标CPP、CO、MAP高(P<0.05),全身血液氧合程度好,D02和VO2高于对照组(P<0.05).结论 在室颤心脏骤停猪模型中,应用规范化标准心肺复苏较不标准者能够明显提高CPP和CO2改善复苏期间的血流动力学,并可以提高DO2和VO2,对氧代谢的改善产生积极作用,因此ROSC成功率明显提高.     

The impact of airway management on quality of cardiopulmonary resuscitation: An observational study in patients during cardiac arrest

Background

Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality.

Methods

Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device.

Results

One hundred patients were enrolled in the study (2008–2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8–19.4) vs LMA median 8.0 s (IQR 5.5–15.9), p = 0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n = 50) improved NFR from baseline median 0.24 IQR 0.17–0.40) to 0.15 to (IQR 0.09–0.28), p = 0.012; LMA (n = 25) from median 0.28 (IQR 0.23–0.40) to 0.13 (IQR 0.11– 0.19), p = 0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n = 25) (median 0.29 (IQR 0.18–0.59) vs median 0.26 (IQR 0.12–0.37), p = 0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups.

Conclusion

The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes.     

Pediatric resuscitation and cardiac arrest

Cardiac arrest in children is, fortunately, a relatively infrequent event. Mortality rate after cardiac arrest is greater than 50%. This article discusses strategies to increase the chance of survival to discharge. These strategies focus on suggestions for organizing a system prepared to care for critically ill children, incorporating the 2010 American Heart Association resuscitation guidelines into clinical practice, and encouraging physicians to become advocates of decreasing the occurrence of pediatric cardiac arrest. Providing the best-prepared system available to care for critically ill children will, it is hoped, decrease the number of preventable deaths in children.     

经股静——动脉心肺转流术心肺脑复苏机制的探讨

目的观察犬电击致室颤/心跳骤停(VF/CA)8min后经开胸心肺复苏(CPR)和/或经股静-动脉心肺转流(CPB)心肺复苏对心脏复苏和脑脊液(CSF)内乳酸(LA)含量的影响.方法采用犬经胸壁电击VF/CA8min,经CPR恢复自主循环(RSC)后观察4h内CSF内LA含量的变化.9只犬分为两组,Ⅰ组(n＝5)采用开胸心脏按压等方法复苏,Ⅱ组(n＝4)于开胸心脏按压同时经一侧股静、动脉心肺转流,并维持2h.结果Ⅱ组RSC时间较Ⅰ组显著缩短(6.3±2.1minvs13.6±5.9min,P＜0.05);Ⅱ组CPB后室颤波幅较Ⅰ组明显提高;Ⅰ组RSC后30、60、120和240minCSF内LA含量均较CA前明显升高(10.7±3.3、8.8±3.8、7.8±3.5、5.6±1.0vs3.2±1.0,P均＜0.05),而Ⅱ组RSC后除30min外各时点CSF内LA含量均较CA前无明显升高(4.1±2.6、3.9±2.4、2.6±1.7vs3.0±0.4,P均＞0.05),且明显低于Ⅰ组各值(P均＜0.05).结论CA后经开胸CPR辅以CPB能提高心脏复苏的有效性,抑制单一开胸CPR后发生的CSF内LA含量升高,提示其能减轻脑内糖无氧代谢,改善脑氧供需关系,对脑复苏有利.