58例心室颤动患者临床分析

为探讨住院心室颤动(室颤)患者的病因分布和存活,出院者的远期生存率,对连续58例经心电监测或心电图证实的室颤住院患者进行回顾性分析和断面随访调查。心功能评价采用NYHA标准。随访方法有家庭走访、门诊和信访,内容包括是否长期服用抗心律失常药物、是否死亡、死亡时间及可能原因。　　临床资料　58例患者中男性37例,年龄68±19岁,女性21例,年龄64±17岁。35例室颤发生于CCU病房,15例发生于心导管室,3例发生于抢救室,5例发生于普通病房。58例患者中复苏失败而死亡16例,除颤成功后72h内死亡4例,存活出院38例。室颤发生于心肌梗塞急性期7…     

医院外室颤复苏后患者的住院病死率

作者回顾281例医院外室颤复苏成功后患者的住院结果。其中,男性227例;年龄14～82(平均58±12)岁。室颤原因包括急性心肌梗塞194例(69%),缺血性心脏病但无心肌梗塞71例(25%),其他或原因不明16例(6%)。住院期间,死亡91例(32%),存活出院190例(68%);两组平均年龄分别为56.0±12和60.8±11岁(P<0.01)。单变数分析显示,住院死亡危险困素为年龄≥60岁,原有心肌梗塞或脑血管疾病,医院外除颤迟延≥5分钟,电击≥4次,除颤成功后继发左心衰竭或肺水肿,心源性休克,入院时昏迷等。多变数分析显示,住院死亡危险因素为除颤后心源性休克,入院时昏迷,年龄≥60岁,电击≥4次等.     

电除颤抢救心脏骤停34例临床观察

心搏骤停（CA）是指各种原因引起心脏射血功能的突然中止。CA发生后,由于脑血流的突然中断,10s左右患者即可出现意识丧失,经及时救治可获存活,否则将发生生物学死亡,罕见自发逆转者。CA属急危重症,若抢救及时、措施得力,能提高抢救成功率。心搏骤停患者大约有80％～90％第一个捕获的心电图是室颤,因而尽早实施电除颤是治疗室颤的有效手段,目前尚没有任何一种方法能够与之相比,除颤越早,成功率越高。我院对34例心脏骤停患者采用电除颤抢救,观察电除颤在心肺复苏中的临床效果,并与非应用电除颤做比较分析,现报道如下。     

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   

心室颤动的抢救配合与护理体会

心脏骤停是猝死的常见原因。心脏骤停多由心室颤动（室颤）引起。故及时有效的除颤及监护是心脏复苏成功的关键。我们近年抢救10例室颤患者存活8例，死亡2例。     

高级生命支持和复苏技术的新观点

院外心脏骤停已经成为世界性的公共卫生问题，美国每年发生约18．4～45万人次，年发生率0．6‰，能到达医院且存活出院者不到5％。新近文献报道心室颤动（室颤）所致院外心脏骤停若能及时电除颤40％能够存活出院。尽管由室颤所致院外心脏骤停逐渐减少，无脉搏性电活动和心室停搏所致者逐渐增加，室颤仍是院外心脏骤停后3～5min的主要节律。最近的随机临床试验取得了很大进展，提示心肺脑复苏高级心脏生命支持指南有必要进行修订H0。     

气管插管和心脏电除颤的时机选择对心肺复苏的影响

目的探讨气管插管和心脏电除颤的时机选择对心肺复苏（cPR）的影响。方法将109例急诊心肺复苏病人，随机分为选择顺序复苏组（A组，55例），常规CPR复苏程序组（B组，54例），对两组复苏成功率进行回顾性分析牌号。结果选择顺序复苏组CPR成功28例（50．9％），高于传统的常规复苏组11例（20．3％），P〉0．05。结论气管插管和心脏电除颤随病因不同而作出顺序选择时机，能大大提高CPR的成功率。     

121例住院患者心室颤动的临床分析

目的探讨患者住院期间心室颤动（VF）的基础原因、复苏影响因素及随访结果,以对医院内、外猝死的抢救有所指导。方法2006年1月1日至12月31日,2所三级医院和12所二级医院住院期间共121例患者发生VF,对其临床资料进行回顾性分析。结果住院期间VF的复苏成功率51．2％;冠心病与非冠心病VF的复苏成功率分别为55．8％和23．5％（P=0．014）;监护区与无监护区VF的复苏成功率分别为80．6％和38．8％（P=0．001）;血钾正常与低钾血症VF复苏成功率58．6％和60．0％（P=0．932）;三级医院与二级医院VF复苏成功率为65．2％和42．7％（P=0．016）;62例复苏成功的VF患者中,住院期间死亡4例,平均随访时间（12±3）个月,随访期间死亡5例。结论住院期间VF的病死率较高;冠心病并发VF的复苏成功率高于非冠心病;直流电除颤是重要的抢救措施;低钾血症不影响VF的复苏成功率;三级医院的复苏成功率高于二级医院。     

93例心脏骤停急救的临床分析

目的探讨心脏骤停提高复苏成功率的因素。方法对93例心脏骤停复苏的结果进行分析,包括:心脏骤停到开始复苏的时间、胸外心脏按压、肾上腺素等药物的用法和电击除颤等方面。结果93例心脏骤停者中复苏成功23例,占24.7％,存活12例,占12.9％。结论心脏骤停时间、胸外心脏按压、肾上腺素等药物的用法和电击除颤均对复苏起重要作用。     

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.     

Analysis of the outcomes of cardiopulmonary resuscitation in an emergency department

OBJECTIVE: The aim of this study is to analyse the factors affecting emergency department (ED) cardiopulmonary resuscitation (CPR) outcome. METHODS: A standard CPR protocol was performed in all patients and certain pre and postresuscitation parameters including age, sex, initial arrest rhythm, primary underlying disease, initiation time of advanced cardiac life support, duration of return of spontaneous circulation were recorded. Patients were followed up to determine rates of successful CPR, survival and one-year survival. RESULTS: From December 1999 to May 2001, 80 consecutive adult patients in whom a standard CPR was performed in the ED were prospectively included in the study. The overall rate for successful CPR, survival and one-year survival were found to be 58.8% (47/80), 15% (12/80) and 10% (8/80), respectively. Survival and one-year survival rates were better in patients with an initial arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) than both pulseless electrical activity (pEA) and asystole; survival and one-year survival rates were better in patients with a primary underlying disease of cardiac origin than non-cardiac origin. Acute myocardial infarction had the best prognosis among conditions causing arrest. Presence of sudden death was found to have a better survival and one-year survival rate. CONCLUSION: Initial cardiac rhythm of VF/pVT, cardiac origin as the primary disease causing cardiopulmonary arrest and presence of sudden death were found to be good prognostic factors in CPR.     

Development of ventricular fibrillations with different characteristics in the local electrocardiogram: large and small amplitude of activation, and its implication for implantable cardioverter defibrillator treatment

An implantable cardioverter defibrillator (ICD) was implanted in 2 patients with ventricular tachyarrhythmia related to old myocardial infarction, and defibrillation tests were attempted at the time of ICD implantation and at 2 or 4 weeks after the operation. Ventricular fibrillation (VF) was induced by T-wave shocks, but the amplitude of the ventricular electrogram was different in each VF. In most of the VFs with large ventricular electrograms, the local activity was appropriately detected. However, many undersensed beats were observed in other VFs that had fine ventricular electrograms and a longer time was needed before delivering the shock. The amplitude of the ventricular electrogram might be small in some cases of VF and this might result in undersensing and/or unsuccessful defibrillation. Close attention must be paid to the amplitude of ventricular activation in each VF to avoid possible difficulty in ICD therapy.     

Precountershock cardiopulmonary resuscitation improves ventricular fibrillation median frequency and myocardial readiness for successful defibrillation from prolonged ventricular fibrillation: a randomized,controlled swine study

STUDY OBJECTIVE: After prolonged ventricular fibrillation (VF), precountershock cardiopulmonary resuscitation (CPR) will improve myocardial "readiness" for defibrillation compared with immediate defibrillation. METHODS: After 10 minutes of untreated VF, 32 swine (27+/-1 kg) were randomly assigned to receive immediate countershocks (DEFIB), CPR for 3 minutes followed by countershocks (CPR), or CPR for 3 minutes plus intravenous epinephrine followed by countershocks (CPR+EPI). VF waveform was evaluated by fast Fourier transformation. RESULTS: VF amplitude and median frequency by fast Fourier transformation decreased during the untreated VF interval in all groups, and the median frequency subsequently increased during each minute of precountershock CPR. Although the VF median frequency in the 3 groups did not differ after 10 minutes of untreated VF (8.9+/-0.8 Hz versus 8.4+/-0.5 Hz versus 7.3+/-0.5 Hz, respectively), immediately before the first shock the VF median frequency was much lower in the DEFIB group than in either the CPR or CPR+EPI groups (8.9+/-0.8 Hz versus 13.1+/-0.8 Hz versus 13.8+/-0.9 Hz, respectively; P <.01). None of the 10 animals in the DEFIB group attained return of spontaneous circulation after the first set of shocks versus 5 of 10 animals in the CPR group and 6 of 12 animals in the CPR+EPI group (DEFIB versus each CPR group; P <.05). Cardiac output 1 hour after resuscitation was substantially worse in the DEFIB group than in the CPR or CPR+EPI groups (74+/-7 mL/kg per minute versus 119+/-7 mL/kg per minute versus 104+/-15 mL/kg per minute; P <.05). CONCLUSION: Precountershock CPR can result in substantial physiologic benefits compared with immediate defibrillation in the setting of prolonged VF. Moreover, these benefits can be attained with or without the addition of intravenous epinephrine.     

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。     

A comparison of biphasic and monophasic waveform defibrillation after prolonged ventricular fibrillation

STUDY OBJECTIVE: To compare the effects of biphasic defibrillation waveforms and conventional monophasic defibrillation waveforms on the success of initial defibrillation, postresuscitation myocardial function, and duration of survival after prolonged duration of untreated ventricular fibrillation (VF), including the effects of epinephrine. DESIGN: Prospective, randomized, animal study. SETTING: Animal laboratory and university-affiliated research and educational institute. PARTICIPANTS: Domestic pigs. INTERVENTIONS: VF was induced in 20 anesthetized domestic pigs receiving mechanical ventilation. After 10 min of untreated VF, the animals were randomized. Defibrillation was attempted with up to three 150-J biphasic waveform shocks or a conventional sequence of 200-J, 300-J, and 360-J monophasic waveform shocks. When reversal of VF was unsuccessful, precordial compression was performed for 1 min, with or without administration of epinephrine. The protocol was repeated until spontaneous circulation was restored or for a maximum of 15 min. MEASUREMENTS AND RESULTS: No significant differences in the success of initial resuscitation or in the duration of survival were observed. However, significantly less impairment of myocardial function followed biphasic shocks. Administration of epinephrine reduced the total electrical energy required for successful resuscitation with both biphasic and monophasic waveform shocks. CONCLUSIONS: Lower-energy biphasic waveform shocks were as effective as conventional higher-energy monophasic waveform shocks for restoration of spontaneous circulation after 10 min of untreated VF. Significantly better postresuscitation myocardial function was observed after biphasic waveform defibrillation. Administration of epinephrine after prolonged cardiac arrest decreased the total energy required for successful resuscitation.     

Bystander CPR in prehospital coarse ventricular fibrillation

Prehospital bystander cardiopulmonary resuscitation (CPR) was studied to determine if it affected the outcome of defibrillation. Four hundred twenty-one consecutive witnessed cardiopulmonary arrests presenting with the initial rhythm of coarse ventricular fibrillation treated by the Milwaukee County Paramedic System from January 1980 to June 1982 were analyzed. Pediatric, trauma, and poisoning patients and those receiving intravenous or endotracheal medications before defibrillation (58) were excluded. Immediate professional bystander CPR (physician, nurse, EMT) and citizen bystander CPR were compared to a control group receiving no bystander CPR until arrival of EMS personnel. A successful defibrillation occurred if defibrillation prior to administration of medication produced an effective cardiac rhythm with pulses. Eighty-eight of the 363 remaining patients (24%) converted with initial defibrillations. While the group receiving professional bystander CPR had a higher successful defibrillation rate than did the no-CPR group (35% vs 22%, P less than .04), citizen bystander CPR and no-CPR groups had similar successful defibrillation rates (24% vs 22%, no significant difference). One hundred eighty-six of the 363 patients (51%) were transported to a hospital with a rhythm and a pulse (a successful resuscitation). Ninety-seven of the 363 patients (27%) were discharged alive from the hospital (a save). Patients who were converted successfully using initial "quick-look" defibrillations were far more likely to be successfully resuscitated (79/88 [90%] vs 107/275 [39%], P greater than .0001) and to be discharged alive from the hospital (54/88 [61%] vs 43/275 [16%], P greater than .0001) than were those who required further advanced cardiac life support techniques.(ABSTRACT TRUNCATED AT 250 WORDS)     

Analysis of factors associated with successful cardiopulmonary resuscitation in non-traumatic dead-on-arrival patients in emergency department

Out-of-hospital cardiopulmonary arrest has a dismal prognosis. Successful resuscitation of these patients depends on the "chain of survival". In Taiwan, the emergency medical services (EMS) system is under development and the links of "chain of survival" are weak and frequently broken. A 2-year retrospective study was conducted from January, 1999, to December, 2000 to evaluate the factors of successful cardiopulmonary resuscitation (CPR) in non-traumatic DOA patients in ED. Of 175 studied patients, 51 patients (29.1%) were successfully resuscitated with return of spontaneous circulation (ROSC), but only 7 patients (4%) survived to hospital discharge. Most successfully resuscitated patients (84.3%) regained their vital signs within 30 minutes. There were no significant differences in age, sex, vehicle of transportation, administration of prehospital CPR or not, EMS response interval, on-scene duration, and scene-to-hospital interval between patients with ROSC and without ROSC. Compared with asystole cardiac rhythm, patients with pulseless electrical activity (PEA) had a higher successful resuscitation rate (p = 0.001), but no significant differences existed between patients with ventricular fibrillation/ventricular tachycardia (VF/VT) and PEA or VF/VT and asystole. However, there were no significant differences in the survival discharge rate among patients with different initial cardiac rhythms in ED.     

Double vessel acute myocardial infarction showing simultaneous total occlusion of left anterior descending artery and right coronary artery

Simultaneous double vessel acute myocardial infarction (AMI) is extremely rare and usually has poor clinical outcomes. Management of this complicated condition is challenging and time-limited. The case of a 46-year-old Taiwanese man with simultaneous anterior and inferior wall AMI is reported. Rapid deterioration of clinical condition with ventricular fibrillations (VF), cardiogenic shock and asystole developed before catheterization. Coronary angiogram revealed simultaneous total occlusion of left anterior descending (LAD) and right coronary arteries (RCA). Frequent VF attack was still noted after diagnostic catheterization. After cardiopulmonary resuscitation, immediate percutaneous coronary intervention of the LAD and RCA, and intra-aortic balloon counterpulsation was inserted. Due to intractable heart failure and cardiogenic shock, extracorporeal membrane oxygenation was performed. Rabdomyolysis with acute renal failure was also noted with hemodialysis treatment. Thirty-one days after hospitalization, he was discharged with a New York Heart Association functional class III heart failure, without hemodialysis.     

经静脉埋藏式三腔起搏心脏转复除颤器的临床应用

探讨经静脉埋藏式三腔起搏心脏转复除颤器 (BVP ICD)的临床应用。病例入选标准 :①缺血性心脏病、扩张性心肌病合并充血性心力衰竭。②左室射血分数 <0 .35。③QRS波时限 >130ms。④ 2 4h动态心电图、临床心电监护、腔内电生理检查中 ,任一项记录到明确室性心动过速 (VT)或心室颤动 (VF)。采用经锁骨下静脉和头静脉 ,分别置入右室电极导管到右室 ,右房电极导管到右心耳 ,左室电极经冠状静脉窦到冠状静脉后侧支 ,其中 1例为经静脉埋藏三腔双室起搏器 (BVP)升级为BVP ICD。结果 :双室起搏阈值 1.7± 0 .7V ,R波幅度 10 .3± 4mV ,双室电极阻抗 896 .2± 82Ω。4例先后 2次采用电击T波诱发出VT或VF ,并除颤成功。 3例因心功能差仅诱发 1次并除颤成功。最低有效除颤能量 2例 11J ,5例 2 0～ 2 1J ,手术时间 12 9.2 8± 4 7.3min。 7例随访 3～ 12个月 ,心功能改善 1～ 2级。 2例分别各有 1例除颤事件记录 ,7例全部存活。结论 :BVP ICD临床疗效较好 ,但设定首次电击能量时不宜太小 ,力争尽快转复心律 ,以策安全。慎用快速心室起搏 (Ramp)终止VT。     

Rescue Angioplasty in Failed Thrombolysis in Acute Myocardial Infarction: A Community Hospital Experience

OBJECTIVES: To determine the success and survival rate of patients undergoing rescue angioplasty in failed thrombolysis in acute myocardial infarction, in the private practice setting of a tertiary care community hospital. METHODS: Between January 1990, and March 1995 we treated 125 patients with rescue angioplasty after failed thrombolysis for acute myocardial infarction. All patients were brought to the catheterization laboratory and studied if there was no evidence of reperfusion, and rescue angioplasty was performed if the infarct related artery showed TIMI 0D1 flow. Their records were reviewed for the results of the angioplasty, presence of congestive heart failure, and survival during the hospitalization. RESULTS: One hundred and one men and 24 women (ages 21 to 79) were studied, of whom 48 had anterior infarcts, 8 lateral infarcts, and 69 inferior infarcts. Of the 109 patients with successful procedures (87.2%) three died (2.8%). Of the 16 patients with failed procedures, six (37.5%) died (p = 0.00011). Eight of the nine patients who died were in extremis upon entering, or soon after entering the hospital, and would have been expected to die. However, one patient initially successfully recanalized and stabilized, rapidly deteriorated and died when his artery reoccluded and could not be reopened. Patients with congestive heart failure, documented by x-ray, had a higher mortality rate (21.1%) than patients who were free of failure (3.3%, p = 0.017). CONCLUSION: Patients who have a successful rescue angioplasty after failed thrombolysis in acute myocardial infarction have a higher survival rate than those who fail a rescue procedure. Most patients who die are in extremis upon admission.