Disseminated intravascular coagulation is associated with the neurologic outcome of cardiac arrest survivors

Purpose

We aimed to examine the serial changes in coagulofibrinolytic markers that occurred after the restoration of spontaneous circulation (ROSC) in cardiac arrest patients, who were treated with targeted temperature management (TTM). We also evaluated the association between the disseminated intravascular coagulation (DIC) score and clinical outcomes.

心源性心脏骤停心肺复苏成功的分析

目的分析影响心源性心脏骤停患者心肺复苏成功的临床因素。方法选择该院收治的心源性心脏骤停患者共58例,根据复苏成功与否分成心肺复苏成功组(成功组)22例和心肺复苏失败组(失败组)36例。分析两组患者的临床资料,探讨与心肺复苏成功的相关因素。结果两组患者性别比和发病种类比较,差异无统计学意义(P0.05);成功组患者的年龄和入院时间明显低于失败组,院前给予抢救的比例明显高于失败组,差异均有统计学意义(P0.05)。成功组患者的心脏停搏时间、抢救时间、心肺复苏循环平均次数、肾上腺素剂量和电除颤次数明显低于失败组,应用辅助机械通气的比例明显高于失败组,差异均有统计学意义(P0.05)。结论心肺复苏成功的因素可能与发病年龄、入院时间、院前给予抢救的比例、心脏停搏时间、抢救时间、心肺复苏循环次数、肾上腺素剂量、平均电除颤次数和应用辅助机械通气有关。     

弥散性血管内凝血快速实验室诊断指标的价值

目的 对弥散性血管内凝血（DIC）实验室快速诊断指标的敏感性、特异性及其改变的意义进行比较评估，提供理想的检测方案。方法 采用了一般实验室可行的DIC实验室诊断指标如抗凝血酶活性（AT：A，发色底物法）检测、凝血酶原时间（PT）、纤维蛋白原定量（Fbg）、D二聚体（D—D）、鱼精蛋白副凝固试验（3P）、凝血酶凝固时间（TT）等试验。结果 健康正常人77例，临床病例166例，在DIC组AT：A敏感率是91．9％，PT是89．2％，Fbg是86．5％，D—D是82．4％，3P是79．7％，TT是66．2％。结论 目前国内采用的DIC实验室诊断指标快捷实用，并具有一定的特异性和敏感性，但就诊断DIC而言多数存在较高的假阳性与假阴性。     

常规复苏结合纳洛酮及糖皮质激素对心脏骤停患者复苏成功率的影响

目的 探究常规复苏结合纳洛酮及糖皮质激素对心脏骤停患者复苏成功率的影响.方法 回顾性选择2018年2月至2021年1月我院急诊科收治的100例心脏骤停患者作为研究对象,按不同急救方案将其分为对照组(48例,常规复苏+糖皮质激素抢救)与研究组(52例,常规复苏+糖皮质激素+纳洛酮抢救).比较两组的自主呼吸、自主意识及自主...     

Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation

Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P less than 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P less than 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4-6 minutes from the time of collapse and must be followed within 10-12 minutes of the collapse by advanced life support in order to be effective.     

分子标物及常规血凝学指标测定在DIC临床诊断中的价值对比分析

目的对比分析常见血凝学指标和几种血栓前状态分子标志物定量测定在DIC诊断中的价值.方法收集了30例正常人和63例DIC患者标本,根据DIC病程分为DIC早期(初发高凝血期)、中期(消耗性凝血障碍期)和晚期(继发性纤溶亢进期),测定了常规血凝学指标,并用ELISA法测定了血栓前状态分子标志物凝血酶原F1+2、凝血酶-抗凝血酶复合物(TAT)、栓溶二聚体(D-dimer,D-D)含量.结果各期DIC患者的部分常规血凝学指标有一定规律;而分子标志物变化不同.早期DIC中,D-D含量为(1.62±1.46)mg/L,NC组为(0.51±0.12)mg/L;F1+2含量为(4.96±2.78)nmol/L,NC组为(0.73±0.42)nmol/L;TAT含量为(33.11±20.59)μg/L,NC组为(1.64±3.04)μg/L;中期DIC中D-D含量为(6.85±8.37)mg/L;F1+2含量为(4.36±2.44)nmol/L,TAT含量为(22.53±20.98)μg/L;晚期DIC中D-D含量为(10.32±5.85)mg/L,F1+2的含量为(6.44±3.51)nmol/L,TAT含量为(36.64±20.09)μg/L.F1+2与TAT在所有DIC患者中有显著性相关(r=0.679,P＜0.0001),而F1+2与D-D、TAT与D-D无相关性.结论综合应用不同的血栓前状态分子标志物的定量测定和常用血凝学指标,不但有助于早期诊断DIC,并且可用于判断DIC的发展情况.     

Disseminated intravascular coagulation and acute myocardial necrosis caused by lightning

A 24-year-old woman was struck by lightning and suffered 20% second degree burns. She was admitted after cardiac and respiratory arrest. Despite intensive supportive care she died 24 h later of cardiogenic shock complicated by disseminated intravascular coagulation. At autopsy there was myocardial necrosis. Disseminated intravascular coagulation and myocardial necrosis are only rarely described as complications of lightning.     

In-hospital cardiac arrest

In-hospital sudden cardiac arrest and resuscitation is distinct from out-of-hospital sudden cardiac arrest (OOHSCA) and warrants specific attention. Sudden cardiac arrest (SCA) is a manifestation of an underlying process rather than a disease itself. The complex, multiorgan system dysfunction common among the inpatient population can precipitate SCA by both similar and very different mechanisms than OOHSCA. The diagnostic and treatment algorithms of SCA remain largely the same between the inpatient and outpatient arenas. The application of complex diagnostic and therapeutic interventions is permissible, but such tools must not interrupt or delay the important basics of cardiac arrest management in the inpatient setting, including adequate chest compressions and timely defibrillation when appropriate.     

盲肠结扎穿孔建立小鼠弥漫性血管内凝血动物模型的研究

目的应用盲肠结扎穿孔术(CLP)建立小鼠弥漫性血管内凝血(DIC)动物模型。方法将昆明小鼠随机分为假手术组(sham)、中度CLP组(mCLP)和重度CLP组(hCLP),检测术后即刻、2、6、12、24、48、72 h共7个时间点的外周血血小板计数(PLT)、谷丙转氨酶(ALT)、肌酐(Cr)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体,计算72 h各组存活率,并进行组织病理切片观察。结果术后72 h小鼠sham组存活率均为100%,mCLP组存活率为60%,hCLP组存活率为10%(P<0.05)。与sham组相比,mCLP和hCLP组小鼠CLP术后6 h PLT、FIB明显下降,APTT+PT延长,D-二聚体、ALT升高,术后12 h Cr升高(P均<0.05),组织病理显示肺和肠系膜出现不同程度的微血栓形成。结论 CLP小鼠模型能够体现类似临床的DIC的发展过程,重度CLP小鼠模型可作为脓毒症性DIC研究的动物模型。     

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.     

Evaluation of the outcome of out-of-hospital cardiac arrest resuscitation efforts in Denizli, Turkey

The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27-13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.     

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.     

急性白血病合并弥散性血管内凝血41例

目的探讨急性白血病（AL）合并弥散性血管内凝血（DIC）的临床特点及诊治经验。方法回顾性分忻41例AL合并DIC患者的临床资料,包括：白血病分型、临床症状、DIC发生的时间、实验室检查的相关结果及疗效等。结果AL尤其是急性早幼粒细胞白血病合并DIC 90％发生在白血病治疗前,肝素治疗AL合并DIC总有效率为75．6％,低分子肝素与小剂量普通肝素的疗效相同。结论急性早幼粒细胞白血病合并DIC防治的重点是在初发期;出血尤其是颅内出血是AL合并DIC死亡的重要原因;积极治疗原发疾病,有效的抗凝治疗及补充凝血因子是治疗成功的关键。     

心肺复苏中机械通气时机选择对急诊心博骤停患者预后的影响

目的探讨心肺复苏的机械通气时机选择对急诊心博骤停患者预后影响。方法选取在本院接受心博骤停自动循环恢复机械通气的50例患者为研究对象，按照机械通气的时间分为早期上机组24例，以及晚期上机组26例，统计两组患者的年龄、性别、心博骤停心率类型以及心博骤停的原因，同时统计两组患者心肺复苏成功效率、心博骤停24 h、有无角膜性反射、有无瞳孔反射、疼痛躲避反应、运动反应、出院时神经功能分类以及治愈出院率。对两组患者的各项指标进行相应比较。结果两组患者的年龄、性别、心博骤停心率类型以及心博骤停原因，两者差异无统计学意义（ P＞0．05）；两组患者的心肺复苏率、24 h角膜反射（＋）、24 h瞳孔反射（＋）、24 h疼痛躲避反应（＋）、24 h运动反应（＋）以及其出院时神经功能分类等，其指标差异有统计学意义，早期上机组明显优于晚期上机组（ P＜0．05）；两组患者成活出院率（45．5％∶40．0％）之间差异无统计学意义（ P＞0．05），其总成活出院率为33．41％。结论对心博骤停的患者应及早给予机械通气呼吸支持，从而促进患者心脏的恢复，以提高心博骤停疾病患者的治疗效果，提高心博骤停患者心肺复苏的成功率，并且对其神经功能的预后进行改善。     

心肺复苏的质量对复苏后炎症反应的影响

目的 评价临床上常见的不标准心肺复苏(N-CPR)和2005年国际CPR指南推荐的标准心肺复苏(S-CPR)对心脏停搏(CA)猪复苏后炎症反应的影响.方法 18头猪被随机均分成两组,经麻醉、插管、机械通气后,应用程控刺激方法制备心室纤颤(VF)模型.S-CPR组应用2005年指南推荐的CPR方式;N-CPR组模拟临床上经常出现的低质量CPR方式.VF 4 min后开始进行CPR,CPR 9 min后进行电除颤及高级生命支持,自主循环恢复(ROSC)后进行各项指标观察.24 h仍存活的猪经处死后取脑、心、肝、肾组织,应用免疫组化法检测核转录因子-kB(NF-kB)的表达.实验期间连续监测CPR后3、6和9 min的血流动力学变化,并抽取基础状态、CPR 9 rain、ROSC 4 h的静脉血,测定血清肿瘤坏死因子-a(TNF-α)、白细胞介素-1β(IL-1β)的浓度.结果 与N-CPR组比较,S-CPR组ROSC率(22.2%比88.9%)及24 h存活率(22.2%比88.9%)明显提高(P均＜0.05);CPR后3、6和9 min心排血量(CO)和平均动脉压(MAP)也均显著升高(P均＜0.01);并且CPR后9 min和ROSC 4 h血清促炎症因子TNF-α、IL-1β]水平和各组织NF-kB表达程度均降低.结论 高质量的CPR后不仅能提高CA猪的生存率,也明显改善CPR后的炎症反应.     

弥散性血管内凝血患者D-二聚体实验室检测分析

目的评价弥散性血管内凝血（DIC）患者体内D-二聚体水平,探讨DIC患者应用D-二聚体检查的临床价值。方法对该院收治的30例DIC患者（DIC组）及30例非DIC患者（对照组）进行D-二聚体检测,比较2组患者D-二聚体水平。同时按照DIC分期将30例DIC患者分为高凝期组、消耗性低凝期组及纤溶亢进期组,比较不同时期患者体内D-二聚体的水平并探讨两者间的相关性。结果 DIC组患者D-二聚体水平明显高于对照组患者,差异有统计学意义（t=11.229,P=0.000）,而纤溶亢进期患者体内D-二聚体水平最高,其次为消耗性低凝期,高凝期最低,差异有统计学意义（Z=-4.785,P=0.000）。同时DIC患者体内D-二聚体水平与DIC分期存在显著的正向直线相关关系（R=0.982,P=0.000）。结论 DIC患者体内D-二聚体水平明显高于非DIC患者,且DIC不同时期D-二聚体水平也存在差异,可用于对DIC患者病情的预测。     

血浆置换在小儿弥散性血管内凝血的治疗作用

目的观察血浆置换在小儿弥散性血管内凝血治疗中的作用。方法选择临床确诊为小儿弥散性血管内凝血的患儿34例,在积极治疗原发病的基础上给予血浆置换治疗,观察血浆置换前后患儿的出血情况,凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(Fib)、抗凝血酶Ⅲ(ATⅢ)及D-二聚体等指标变化。结果通过血浆置换治疗后,34例患儿出血情况减轻,除血小板变化不大外,PT、APTT及Fib明显改善,ATⅢ明显升高,D-二聚体明显降低。结论血浆置换在小儿弥散性血管内凝血的治疗中临床疗效显著。     

肾上腺素与血管加压素对窒息性心脏骤停大鼠早期心肺复苏的影响

目的：比较肾上腺素与血管加压素对室息性心脏骤停大鼠早期心肺复苏的影响。方法：健康SI）夫鼠48只,体重200～250g,雌雄产拘,将大鼠随机分成4组（n=12）：正常对照组（C组）、模型组（M组）、肾上腺素组（E组）和血管加雎素组（V组）。M组、E组及V绀大鼠均经气管夹闭1min,建立窒息性心脏骤停模型。肖窒息时间达1min时,分别在常规心肺复苏前：c组和M组大鼠经股静脉注射生理盐水1m1。E组及V纰大鼠经股静脉分别注射肾上腺素0．04mg／kg及血管加压素0．4u／kg,H时开始胸外心脏按压及机械通气,观察自主循环恢复情况,5min无效则放弃复苏。自主循环恢复的大鼠连续监测心电和血压30min。记录在CPR30min内自主循环恢复情况及血流动力学;记录CPR30rain后,采用免疫组织化学法检测各组实验大鼠血清中肿瘤坏死因子-水平、白细胞介素6及白细胞介素10水平。结果：E、V组大鼠自主循环恢复率均显著高于M组（分别为73．4％．74．6％,和15．3％,P〈0．05）．E组大鼠自主循环恢复牢与V组比较差异无统计学意义（P〉0．05）;E、V组大鼠平均动脉压明显高于M绀大鼠（P〈0．05）,V组大鼠MAP高于E组大鼠。差异有统计学意义（P〈0．05）。M组大鼠血清中自细胞介素6及肿瘤坏死因子-水平与E、V组差异有统计学意义（P〈0．05）;E组大鼠m清中肿瘤坏死阔子-及白细胞介素-6水平高于V组（P〈0．05）。E组大鼠血清中白细胞介素-10水平低于V组（P〈0．05）。结论：肾卜腺素与血管加压素在窒息性心脏骤停大鼠早期心肺复苏过程中复苏成功牢无明显差异,但血管加乐素町维持大鼠复苏后平均动脉搓在相对较高水平;同时血管加压素可提高复苏后大鼠血清中抗炎因子水平。