呼吸心跳骤停病人抢救工作流程图在急诊抢救中的应用

目的 通过编制呼吸心跳骤停病人抢救工作流程图，优化急症病人人院抢救流程，改善急救护理服务，建立一条优质、高效、快捷的急救病人流程．提高抢救成功率及病人的满意度。方法 80例病人采用自行设计的呼吸心跳骤停病人抢救工作流程图进行急救护理工作．对照组80例病人采用常规抢救方法进行急救护理工作，两组密切观察抢救时间和抢救成功率。结果 使用呼吸心跳骤停病人抢救工作流程图后抢救病人时间平均缩短18min，抢救成功率由87％提高到93％，病人满意度由90％提高至98％。结论 应用呼吸心跳骤停病人抢救工作流程图．优化抢救程序，将抢救措施程序化、规范化。护理人员相互配合，快速有效地进行急救．为病人赢得时间，提高病人生存质量。     

并联式呼吸心跳骤停抢救流程在急诊抢救中的应用

目的 通过自行设计并联式呼吸心跳骤停病人抢救工作流程,建立一条优质、高效、快捷的急救病人流程,缩短抢救时间,提高抢救成功率.方法 观察组32例呼吸心跳骤停病人,采用自行设计的并联式呼吸心跳骤停病人抢救工作流程;对照组32例呼吸心跳骤停病人,采用常规、传统的抢救方法.密切观察两组抢救所需时间和抢救成功率.结果 应用自行设计的并联式呼吸心跳骤停病人抢救流程后,抢救病人时间平均缩短了13 min.抢救成功率提高了25.0%.结论 应用自行设计的并联式呼吸心跳骤停病人抢救工作流程,优化了抢救程序,从而使抢救措施更加规范化,医护间相互配合,快速有效地进行急救,为病人赢得了救治时间,有效提高了病人的生存质量.     

快速反应小组的构建及运行效果研究

目的探讨成立快速反应小组对普通病房患者抢救成功率的影响。方法建立快速反应小组,应用改良早期预警评分系统,运行快速反应小组联合院内急救医疗小组急救模式,并加强质量控制。结果快速反应小组运行1年后,院内急救医疗小组启动率下降(P0.05),非计划性ICU入住率下降(P0.01)。结论运行快速反应小组有助于医护人员对危重患者的辨别和反应能力,降低心跳骤停和猝死等恶性事件发生,减少非计划性重症监护病房入住率。     

链式流程在心肺复苏急救中的应用

目的探讨应用链式流程在心肺复苏(CPR)急救中的时效性,提高CPR救治成功率。方法将126例呼吸心跳骤停患者按照时间顺序分为对照组54例和观察组72例。对照组采用传统模式救治,观察组采用链式抢救流程救治。结果两组5min内基本生命支持完成率和抢救成功率比较有显著性差异(P<0.01,P<0.05)。结论应用链式流程将各项急救技术进行优化整合,规范急救流程,缩短急救时间,可提高急救效率和抢救成功率。     

专业人员在院内心跳呼吸骤停患者抢救中的效果评价

目的:探讨专业人员在院内心跳呼吸骤停患者抢救中的效果。方法:回顾性分析我院院内专业急救小组成立前2012-01-2013-12期间80例心跳呼吸骤停患者(对照组)临床资料及我院急救小组成立后2014-06-2016-06期间80例心跳呼吸骤停患者(试验组)临床资料,对比两组患者抢救成功率、各项操作开始与所需时间、循环自主恢复时间。结果:试验组患者复苏成功率明显高于对照组(P0.05);试验组除颤开始时间、气道开放时间与复苏需要时长均明显短于对照组(P0.05);试验组患者自主循环恢复时间明显较早。结论:院内急救小队的成立提高了心跳呼吸骤停患者抢救成功率,缩短了抢救时间,值得临床推广应用。     

优化服务流程在急诊抢救患者中的应用效果评价

目的:探讨优化服务流程在急诊抢救患者中的应用效果。方法:将优化服务流程前与优化服务流程后的患者各80例划分成对照组和实验组,对照组应用传统急诊服务流程,实验组通过加强院前、院内急救的一体化建设,建立预检分诊系统,开通绿色通道,缩小功能区的服务半径,专科前移,建立应急预案,成立应急小组等措施优化服务流程,比较两组的就诊等待时间、急诊诊疗时间、满意度、抢救成功率。结果:优化服务流程后急诊抢救患者就诊等待时间和急诊全程诊疗时间缩短,患者及家属满意度和抢救成功率提高。结论:优化服务流程可缩短急诊患者就诊等待时间及急诊诊疗时间,提高患者的满意度及抢救成功率。     

基于流程再造理论优化急救流程对急性心肌梗死患者抢救结局的影响

目的探讨基于流程再造理论优化急救流程对急性心肌梗死(AMI)患者抢救结局的影响。方法选择2015年1月至2018年10月我院抢救的98例AMI患者为研究对象。将本院优化流程护理实施前收治的AMI患者48例作为对照组,实施后收治的AMI患者50例作为观察组。对照组采取常规护理,观察组基于流程再造理论优化急救流程干预。比较两组急救效率及临床结局。结果观察组急诊用时、急救总用时均短于对照组(P 0. 05);观察组急救成功率、护理满意度评分均高于对照组(P 0. 05);观察组院内复发率、HAMA评分和HAMD评分均低于对照组(P 0. 05)。结论对AMI患者采用基于流程再造理论优化急救流程干预,能够缩短急诊时间和急救总用时,提高抢救成功率,降低院内复发率,有利于改善患者的焦虑、抑郁情绪,提高护理满意度,值得临床推广应用。     

心肺脑复苏中实施医护多人分组配合流程的体会

报道医护多人分组配合流程用于抢救心跳呼吸骤停患者的方法 与体会.参考心肺脑复苏抢救程序,实行6名医护分组配合流程:根据位置设3个抢救小组,每组又分主抢救者1名及配合者1名.同时按心肺脑复苏的抢救程序AB、C、DE赋予每组名称,确认C抢救小组中的主抢救者为抢救主持人,参与抢救的医护人员以主持人医嘱为准.为实施医护多人分组配合流程,定期组织科内护理人员学习流程,熟练掌握心肺脑复苏的理论知识、操作流程;定期进行心肺脑复苏的各单项技能和气管插管训练;定期培训团队协作和领导技能等.本研究应用医护多人分组配合流程用于98例心跳呼吸骤停患者的抢救,心跳呼吸骤停患者复苏成功率43%,较文献报道及实施该流程前的抢救成功率明显提高.     

快速反应系统对住院危重患者抢救成功率的影响

目的提高ICU之外住院危重患者抢救成功率。方法建立与运行快速反应系统(RRS),包括设置住院患者预警指征、建立快速反应小组、修订住院患者病情变化处置流程等措施。结果 RRS运行前后,因病情变化入住ICU的住院患者比率减低、住院患者病情变化至转入ICU间隔时间缩短了2h,入住ICU后病死率下降,差异有统计学意义(P<0.05),在ICU住院时间上的差异无统计学意义(P>0.05),住院患者心肺复苏率明显下降(P=0.001)。结论运行RRS有助于提高ICU之外住院危重患者抢救成功率。     

系统进行护理人员心肺复苏培训的初探

心肺脑复苏是抢救心脏，呼吸骤停及保护恢复大脑功能的急救医疗技术，它主要以人工呼吸，胸外心脏按压，电击除颤构成。能否正确、及时、有效地实施心肺脑复苏，是复苏成败的关键。我们想通过模拟急救系统进行护理人员心肺复苏培训，以培养提高急诊护士的急救技术水平，配合能力及应急能力，提高心脏、呼吸骤停患者的复苏成功率及确保复苏后患者的生活质量。     

六西格玛管理法在急诊心肺复苏患者护理中的效果

目的探讨六西格玛管理法在急诊心肺复苏患者护理中的效果。方法选取我院收治的60例心源性心脏骤停患者,采用掷骰子法将奇数患者纳入对照组(30例,常规急诊心肺复苏护理),偶数患者纳入干预组(30例,六西格玛管理法护理)。比较两组的护理效果。结果护理后,干预组的EVLWI、ITVBI、SVRI及并发症总发生率均低于对照组(P<0.05)。干预组的护理满意度高于对照组(P<0.05)。结论六西格玛管理法在急诊心肺复苏患者护理中的效果显著。     

The influence of urban, suburban, or rural locale on survival from refractory prehospital cardiac arrest

There are many variables that can have an effect on survival in cardiopulmonary arrest. This study examined the effect of urban, suburban, or rural location on the outcome of prehospital cardiac arrest as a secondary end point in a study evaluating the effect of bicarbonate on survival. The proportion of survivors within a type of EMS provider system as well as response times were compared. This prospective, randomized, double-blind clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered by prehospital urban, suburban, and rural regional EMS area. Population density (patients per square mile) calculation allowed classification into urban (>2000/mi2), suburban (>400/mi2), and rural (0-399/mi2) systems. This group underwent standard advanced cardiac life support (ACLS) intervention with or without early empiric administration of bicarbonate in a 1-mEq/kg dose. A group of demographic, diagnostic, and therapeutic variables were analyzed for their effect on survival. Times were measured from collapse until onset of medical intervention and survival measured as the presence of ED vital signs on arrival. Data analysis used chi-squared with Pearson correlation for survivorship and Student t test comparisons for response times. The overall survival rate was approximately 13.9% (110 of 793), ranging from 9% rural, 14% for suburban, and 23% for urban sites for 372 patients (P=.007). Survival differences were associated with classification of arrest locale in this sample-best for urban, suburban, followed by rural sites. There was no difference in time to bystander cardiopulmonary resuscitation, but medical response time (basic life support) was decreased for suburban or urban sites, and intervention (ACLS) and transport times were decreased for suburban sites alone. Although response times were differentiated by location, they were not necessarily predictive of survival. Factors other than response time such as patient population or resuscitation skill could influence survival from cardiac arrest occurring in diverse prehospital service areas.     

Beyond the intensive care unit: a review of interventions aimed at anticipating and preventing in-hospital cardiopulmonary arrest

Despite more than four decades of experience with in-hospital cardiopulmonary arrest, outcomes have remained poor. Numerous studies have documented the physiological instability leading to clinical deterioration, which often precedes cardiopulmonary arrest. These physiological changes often go unrecognized or are acted upon inadequately. This has led to the development of interventions aimed at anticipating and/or preventing cardiopulmonary arrest. In this review, we summarize the current literature regarding outcomes from in-hospital cardiopulmonary arrest, the physiological instability leading to clinical deterioration which often precedes cardiopulmonary arrest, and the various interventions to anticipate and prevent in-hospital cardiopulmonary arrest. These interventions include the use of intermediate care units, Modified Early Warning Scores (MEWS) and Medical Emergency Teams (MET). These interventions may have the potential to decrease the cardiac arrest rate and in-hospital mortality rate associated with cardiac arrest; however, controversy remains regarding some of these interventions. The use of intermediate care units may require an organized approach to identify patients who are acutely ill and would benefit from this specialized care. There is not enough evidence currently to support the benefit of Modified Early Warning Scores to prevent in-hospital cardiopulmonary arrest. Recent studies of the Medical Emergency Team have shown a significant decrease in cardiac arrest and overall mortality rates with this intervention. The Medical Emergency Team is an intervention, which requires further studies to define its role in other aspects of hospital patient care.     

山莨菪碱对心脏骤停患者氧化应激及心肺复苏效果的影响

目的:探讨山莨菪碱对心脏骤停患者氧化应激及心肺复苏效果的影响。方法:选择急诊科抢救的心脏骤停患者119例,骤停时间≤10min,随机分为对照组和干预组。两组均按照美国心脏学会心肺复苏指南进行标准的心肺复苏,干预组在标准心肺复苏基础上静脉注射山莨菪碱,比较两组患者自主循环恢复(ROSC)率及复苏后24h存活率;分别在自主循环恢复后和复苏24h后测定血清总超氧化物岐化酶(T-SOD)活力、总抗氧化力(T-AOC)和丙二醛(MDA)含量,比较两组间差别。结果:干预组患者自主循环恢复率与对照组比较差异无统计学意义(P>0.01);复苏24h后,干预组患者存活率显著高于对照组(P<0.01);自主循环恢复后及复苏24h后,干预组T-SOD活力和T-AOC显著高于对照组,MDA含量显著低于对照组(P<0.01)。结论:早期应用山莨菪碱可能会减轻心脏骤停患者体内氧化应激,可能有助于提高复苏后24h存活率,但对于短期自主循环的恢复可能没有明显改善。     

依达拉奉对心肺复苏后大鼠脑神经细胞的保护作用

目的:研究依达拉奉对心肺复苏后大鼠脑神经元的保护作用及机制。方法:随机选取SD大鼠36只,采用窒息合并冰氯化钾停跳液致大鼠心跳骤停5min后开始心肺复苏的动物模型,随机分为假手术组、常规复苏组和依达拉奉治疗组,每组12只。复苏后48h取组织标本,采用比色法测定脑组织中丙二醛(MDA)含量及超氧化物歧化酶(SOD)活力,应用原位末端标记(TUNEL)法检测脑神经细胞凋亡水平。结果:依达拉奉治疗组与常规复苏组相比,脑组织中MDA含量显著降低(P<0.05),SOD活力显著升高(P<0.05);同时依达拉奉治疗组的脑神经元凋亡水平比常规复苏组显著减少(P<0.05)。结论:依达拉奉能有效对抗心肺复苏后大鼠脑细胞的再灌注损伤,减少神经元凋亡。     

How does interruption of cardiopulmonary resuscitation affect survival from cardiac arrest?

PURPOSE OF REVIEW: Survival rates from cardiac arrest are unacceptably low. The present review aims to summarize recent contributions to cardiopulmonary resuscitation research in relation to hemodynamic consequences and especially survival resulting from interruption of chest compressions for defibrillation and rescue breathing. RECENT FINDINGS: Data from animal and human studies strongly support the negative consequences for overall survival when cardiopulmonary resuscitation is interrupted for rescue breathing and rhythm analysis. Furthermore, in settings of prolonged cardiac arrest, electrical defibrillation may not have the highest priority as initial intervention. SUMMARY: Interruption of cardiopulmonary resuscitation negatively affects survival from cardiac arrest. Fewer interruptions for interventions and interventions that take less time may improve survival.     

Testing an Exercise Intervention to Improve Aerobic Conditioning and Autonomic Function after an Implantable Cardioverter Defibrillator (ICD)

Background: Implantable cardioverter defibrillators (ICDs) are an increasingly common treatment for survivors of sudden cardiac arrest or others with life‐threatening ventricular arrhythmias. Health‐care providers are often reluctant to prescribe exercise for this group because of the belief that it will provoke ventricular arrhythmias and cardiac arrest; patients are often afraid to exercise because of concern over receiving an ICD shock. A social cognitive theory‐driven exercise intervention aimed at stabilizing cardiac arrhythmias and reducing ICD shocks by increasing parasympathetic autonomic nervous system control is described. Methods: The exercise intervention has two phases that include an 8‐week aerobic conditioning component followed by a 16‐week exercise maintenance component. The aerobic exercise intervention is expected to have significant impact on cardiopulmonary function, ventricular arrhythmias, cardiac autonomic function, and self‐efficacy in persons who have an ICD. The exercise intervention is currently being tested using a randomized clinical trial format, the results of which will be available in 2012. Conclusion: The exercise after ICD trial is one of the first clinical trials to test the effects of aerobic exercise on cardiopulmonary outcomes after receiving an ICD for primary or secondary prevention of sudden cardiac arrest. (PACE 2010; 973–980)     

Long-term prognosis after out-of-hospital cardiac arrest and primary percutaneous coronary intervention

AIMS: To study the long-term survival after out-of-hospital cardiac arrest and successful cardiopulmonary resuscitation (CPR) in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS: In-hospital and 2-year survival of 40 patients treated with primary PCI after out-of-hospital cardiac arrest and STEMI was compared with that of a reference group of 325 STEMI patients, without cardiac arrest, also treated with primary PCI in the same period. RESULTS: In the group with out-of-hospital cardiac arrest, both in-hospital and 2-year mortality was 27.5%. In the reference group, in-hospital and 2-year mortality was 4.9 and 7.1%, respectively. After discharge from hospital there was no significant difference in mortality between the groups. CONCLUSION: Long-term prognosis is good in selected patients after successful out-of-hospital CPR and STEMI treated with primary PCI.     

Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support

OBJECTIVE: Mechanical circulatory support can maintain vital organ perfusion in patients with cardiac failure unresponsive to standard pharmacologic treatment. The purpose of the current study was to report complication and survival rates in patients supported with emergency percutaneous venoarterial cardiopulmonary bypass because of prolonged cardiogenic shock or cardiopulmonary arrest. DESIGN: Retrospective clinical study. SUBJECTS: A total of 46 patients supported with venoarterial cardiopulmonary bypass, 25 because of cardiogenic shock unresponsive to pharmacologic therapy and 21 because of cardiopulmonary arrest unresponsive to standard advanced cardiac life support. RESULTS: In 41 of the 46 patients (89%), stable extracorporeal circulation was established; in five patients (11%), femoral cannulation was accomplished only after a surgical cutdown. A total of 28 patients were weaned from cardiopulmonary bypass (19 of 25 patients with cardiogenic shock vs. 9 of 21 patients with cardiopulmonary arrest, p =.03), and 13 patients had long-term survival (10 of 25 patients with cardiogenic shock vs. 3 of 21 patients with cardiopulmonary arrest, p =.1). Complications directly related to the use of cardiopulmonary bypass were found in 18 patients (39%), major complications related to femoral cannulation being the most common single cause for bypass-associated morbidity (eight patients, 17%). CONCLUSIONS: Long-term survival rates after emergency percutaneous cardiopulmonary bypass are encouraging in patients with an underlying cardiocirculatory disease amenable to immediate corrective intervention (angioplasty, surgery, transplantation).     

左卡尼汀对心肺复苏后大鼠肾脏保护作用的实验研究

目的 通过观察左卡尼汀对复苏后大鼠血清、肾组织中细胞因子的影响,探讨左卡尼汀对复苏后肾脏保护作用的机制.方法 建立心肺复苏大鼠模型,30只Wistar大鼠随机分为手术对照组(S组)、常规复苏组(C组)和左卡尼汀组(L组),每组10只,S组只行手术操作,不致颤;C组造成心搏骤停并行常规复苏;L组在心搏骤停并复苏成功后静脉注射左卡尼汀.动态观察,血清中TNF-α、IL-1β、iNOS、SU、Scr及肾组织中TNF-α、IL-1β、iNOS的变化.结果 与S组比较,C组和L组复苏成功后血清TNF-α、IL-1β、iNOS、SU、Scr及肾组织TNF-α、IL-1β、iNOS有不同程度升高(P＜0.01).L组与同时相C组比较,血清TNF-α、IL-1β、iNOS、SU、Scr及肾组织TNF-α、IL-1β、iN-OS升高程度减轻(P＜0.05).结论 左卡尼汀能减轻炎性细胞因子介导的肾脏损伤,对复苏后肾脏有保护作用.