急诊科心肺复苏术成功率影响因素分析

目的探讨急诊科心肺复苏成功率的影响因素,以利提高急诊科救治水平。方法回顾性分析326例患者实行心肺复苏救治的过程。结果患者性别和肾上腺素使用方法与心肺复苏的成功率无关;有无目击者及是否及时除颤与心肺复苏的成功率有关（P〈0．05）;有无目击者、是否专业急救人员、是否启动EMSS、是否5min内心肺复苏与心肺复苏的成功率有关（P〈0．01）。结论普及心肺复苏急救知识,提高公众急救意识,加强急诊科建设及专业素质培养,可提高抢救成功率。     

萨勃心肺复苏机抢救心脏骤停患者的效果

目的 评价心肺复苏机抢救心脏骤停患者的治疗效果。方法 将院内抢救的247例心脏骤停患者随机分为两组,分别用萨勃机进行心肺复苏（萨勃机组,n=112例）和采用标准心肺复苏法进行复苏（标准复苏组,n=135例）,除颤、药物应用等基本相同。比较两种方法对心肺复苏成功率及存活率的影响。结果 两组患者抢救开始前的临床状况（年龄、性别、心率、呼吸频率、血压、血氧饱和度和病因类别等均无显著差异,萨勃机组复苏成功率（46.4%）和患者存活率（16.1%）均显著高于标准复苏组（分别是11.1%和4.4%）,差异有统计学意义（均P<0.05）。结论 萨勃机急救心脏骤停患者的效果优于标准心肺复苏法。     

心脏骤停心肺复苏49例临床分析

目的分析心脏骤停患者心肺复苏的成功率。方法对2006年7月～2010年3月我院抢救的49例心脏骤停患者的临床资料、抢救措施及复苏成功率进行回顾性分析。结果 49例患者复苏成功率为20.4%,死亡率为79.6%。院内和院前发生呼吸心脏骤停的患者,复苏成功率分别为30.8%和8.7%,差异有统计学意义（P〈0.01）。复苏开始时间〈5 min和≥5 min的患者复苏成功率分别为32.1%和4.8%,差异亦有统计学意义（P〈0.05）。结论心肺复苏成功率较低,尤其是院前发生呼吸心脏骤停的患者,应普及心肺复苏知识,缩短复苏开始时间,加强急救体系建设,以期提高复苏成功率。     

Swan-Ganz飘浮导管监测血流动力学指标在心肺复苏中指导价值

目的探讨利用Swan-Ganz飘浮导管监测胸外按压时血液流动力指标来指导胸外按压的幅度及频率、呼吸频率及呼吸末正压的调整的研究价值。方法选取我院从2014年7月至2015年7月68例进入急诊抢救室进行心肺复苏的患者,随机分为A、B两组,A组为治疗组,B组为观察组,每组各34例。A、B两组患者在Swan-Ganz飘浮导管置入前,均采用2010指南标准进行心肺复苏术,包括气管插管、除颤、药物的使用并详细记录,A组患者在胸外按压的同时进行Swan-Ganz Swan-Ganz飘浮导管置入,B组为观察组。对比治疗后两组患者心肺复苏的成功率和24 h存活率差异是否有统计学意义。结果 A组心肺复苏成功率为82.35%,B组心肺复苏成功率为64.71%,两组数据比较,差异具有统计学意义(P0.05);A组患者24 h的存活率为91.18%,而B组患者在24 h的存活率仅为79.42%,两组比较差异具有统计学意义(P0.05)。结论利用Swan-Ganz飘浮导管监测血流动力指标来指导胸外按压的幅度及频率、呼吸频率及呼吸末正压的调整以形成有效的右心室峰压及胸腔负压,达到理想的冠状动脉灌注压和心输出量以保证心肌细胞及脑细胞的血液供应,建立个体化的复苏模式从而提高心肺复苏的成功率及24 h的存活率;同时,这一成果将极大的推进心肺复苏技术的进一步发展,增强胸外按压对血流动力学影响的认识。     

院内猝死患者心肺脑复苏抢救中个体化心肺复苏的应用价值

目的探讨个体化心肺复苏在院内猝死患者心脑复苏抢救中的应用价值。方法选取我院2011年1月至2014年6月间治疗监护中发生猝死的患者450例,所有患者均行个性化心肺复苏,作为实验组观察,选取2010年以前行常规心肺复苏的450例患者作为对照组,比较两组即刻复苏成功率和存活率。结果实验组患者即刻复苏成功率为18.67%(84/450),存活率为8.89%(40/450),均明显高于对照组,差异具有统计学意义。结论猝死患者心肺脑复苏抢救中应用个体化心肺复苏可有效地提高即刻复苏成功率和存活率,临床应用价值显著。     

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。     

急诊心肺复苏72例回顾分析

目的探讨影响心肺复苏成功率的因素。方法回顾性分析急诊科进行心肺复苏72例患者的临床资料。结果成功24例,死亡48例,成功率为33.3%。其中救护车转运途中出现心搏骤停的19例患者中,成功2例,死亡17例,成功率为10.5%。性别和年龄与复苏成功率差异无统计学意义(P0.05)。非外伤组的复苏成功率比外伤组高(P0.05)。随着心搏骤停至急诊科开始复苏的时间延长,复苏成功率下降(P0.01)。抢救人员数≤4人组与≥6人组复苏成功率差异有统计学意义(P0.05)。结论非外伤患者的复苏成功率显著高于外伤患者。危重病人转运途中出现心搏骤停,复苏成功率低。早期复苏和足够的人员参与抢救可提高复苏成功率。     

徒手心肺复苏与心肺复苏机在急诊科应用的疗效比较

目的:观察对比徒手心肺复苏与心肺复苏机在急诊科心肺复苏时的疗效。方法:选择2013-01至2015-10于我院急诊科行心肺复苏的患者185例,将患者分为徒手复苏组101例和机械复苏组84例,同时将每组患者的复苏时间以30 min为界分为短时间复苏和长时间复苏,所有患者均给予高质量心肺复苏,分别比较短时间复苏患者和长时间复苏患者在徒手复苏组和机械复苏组的复苏成功率、复苏时间和复苏后血乳酸值。结果:对于短时间复苏患者,徒手复苏组与机械复苏组在复苏成功率、复苏时间及复苏后乳酸值上差异无统计学意义;对于长时间复苏患者,两组在复苏成功率及复苏时间上差异无统计学意义,在复苏后血乳酸方面,机械复苏组(6.88±1.82)mmol/L低于徒手复苏组(9.39±2.39)mmol/L,差异有统计学意义(P0.05)。结论:徒手心肺复苏与心肺复苏机在临床抢救过程中复苏成功率差异无统计学意义,两者同样有效,但心肺复苏机有利于节省人力,特别是对于急诊科人员不足的情况下进行长时间复苏患者,有益于获得更好的代谢疗效,值得临床推广使用。     

心肺复苏成功的因素分析

目的分析心肺复苏成功的因素。方法选取2008—2012年我院收治的行心肺复苏患者45例,将心肺复苏成功患者16例作为观察组,心肺复苏失败患者29例作为对照组。分析影响心肺复苏成功的因素。结果观察组患者年龄60岁、有心脏病基础所占比例低于对照组(P0.05);发病到抢救时间5 min、使用肾上腺素和纳洛酮治疗所占比例高于对照组(P0.05)。结论尽早实施抢救,采取正确方法是心肺复苏成功的关键因素。     

不同心肺复苏程序组合对心搏呼吸骤停患者心肺复苏成功率的影响

目的探讨不同心肺复苏程序组合对心搏呼吸骤停患者心肺复苏成功率的影响。方法选取2010年1月—2013年6月我院救治的心搏呼吸骤停患者120例作为研究组,另选取2006年6月—2009年12月我院救治的心搏呼吸骤停患者120例作为对照组。研究组采用胸部按压-气道-呼吸(C-A-B)程序51例、电除颤和给予复苏药物(D)程序37例、电除颤和给予复苏药物-胸部按压(D-C)程序32例,对照组均采用气道-呼吸-胸部按压-电除颤和给予复苏药物(A-B-C-D)心肺复苏程序。比较两组心肺复苏成功率。结果研究组心肺复苏成功率为14.17%(17/120),高于对照组的8.33%(10/120)(P0.05)。研究组行C-A-B程序心肺复苏成功率为19.61%(10/51),行D-C程序成功率为9.38%(3/32),行D程序成功率为10.81%(4/37)。行C-A-B程序心肺复苏成功率高于行D-C程序和D程序(P0.05);行D-C程序和D程序心肺复苏成功率比较,差异无统计学意义(P=0.124)。结论实施心肺复苏时根据心搏呼吸骤停患者具体情况,灵活地组合心肺复苏程序可提高心肺复苏质量。     

急性心肌梗死心脏骤停患者的院前急救探析

目的探讨急性心肌梗死心脏骤停院前急救特点及效果。方法本次共选取80例急性心肌梗死心脏骤停的患者作研究对象,均为我院急诊科2012年2月至2013年5月收治,行完善的院前急救,回顾分析临床资料。结果本次选取病例中,抢救成功48例,占60％,死亡32例,占40％。抢救成功患者年龄〉165岁占25％（4／16）,明显少于死亡组70．8％（17,24）,CPR、电除颤时间明显早于死亡组,气管插管人数抢救成功组为18．8％（3／16）,明显低于死亡组45．8％（11／24）,差异均有统计学意义（P〈0．05）。结论加强急救网络的配置,普及急救知识,对院前急救流程行完善建立,加强规范救治,可显著提高急性心肌梗死心脏骤停患者的救治成功率,保障患者生命安全,具有非常积极的意义,需引起各级部门重视。     

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 and implementation of resuscitation guidelines: a personal experience

OBJECTIVES: to develop and implement guidelines on the appropriate use of cardiopulmonary resuscitation, which would ensure patient involvement in decision-making about cardiopulmonary resuscitation whenever possible but without offering illusory choices where resuscitation was unlikely to succeed. DESIGN: quantitative guidelines were developed after a review of the literature on survival after cardiopulmonary resuscitation. Patients were classified according to their estimated likelihood of survival to discharge after resuscitation: < 1%, group A; 1-10%, group B; and > 10%, group C. Qualitative guidelines were developed after consideration of the legal and ethical principles of cardiopulmonary resuscitation. It was decided to inform competent patients in group A that cardiopulmonary resuscitation would be inappropriate, and to seek the preferences of competent patients in group B. The operation of the guidelines was examined in patients aged 65 years or more admitted under a single consultant in an acute community hospital. RESULTS: 147 patients were studied: 39 in group A, 26 in group B and 82 in group C. Of 36 patients in groups A and B judged competent, cardiopulmonary resuscitation discussions were only undertaken in 17, usually because acute distress or anxiety precluded effective communication. Of the 23 patients or family members from whom cardiopulmonary resuscitation preferences were sought, four opted for full cardiopulmonary resuscitation and six for limited cardiopulmonary resuscitation (usually witnessed-arrest only and no ventilation). CONCLUSION: it is difficult to involve acutely ill elderly patients in cardiopulmonary resuscitation decision-making. Limited cardiopulmonary resuscitation is a useful option for patients, relatives and doctors.     

The history of the coronary care unit

The first coronary care units were established in the early 1960s in an attempt to reduce mortality from acute myocardial infarction. Pioneering cardiologists recognized the threat of death due to malignant arrhythmias in the postinfarction setting, and developed techniques for successful external defibrillation. The ability to abort sudden death led to continuous monitoring of the cardiac rhythm and an organized system of cardiopulmonary resuscitation, incorporating external defibrillation with cardiac drugs and specialized equipment. Arrhythmia monitoring and cardiopulmonary resuscitation could be performed by trained nursing staff, which eliminated delays in treatment and significantly reduced mortality. These early triumphs in aborting sudden death led to the development of techniques to treat cardiogenic shock, limit infarct size and initiate prehospital coronary care, all of which laid the foundation for the current era of interventional cardiology.     

Prognosis of patients admitted to the coronary or intensive care unita after an out of hospital episode of sudden death]

INTRODUCTION AND OBJECTIVE: Out of hospital sudden death constitutes a major sanitary problem. Early diagnosis and treatment are considered as the most important factors related with short term prognosis. However, there is little information about the outcome of patients admitted to the hospital after a successful recovery from an episode of sudden death outside the hospital. The objective of this study was to analyze the prognosis of patients who initially recovered after an episode of out-of-hospital cardiac arrest and who were admitted to the coronary or intensive care unit. PATIENTS AND METHODS: The clinical characteristics and outcome of 110 consecutive patients admitted to the coronary and intensive care units after an episode of extrahospital sudden death, who initially recovered with success, were retrospectively studied. RESULTS: A total of 33 (30%) patients were discharged alive and without severe neurological damage, 67 (61%) patients died before discharge from hospital and 77 (70%) died or presented severe and permanent neurological damage. The latter group versus those who survived was older (63.6 +/- 13.5 vs 55.2 +/- 12.6 years old; p < 0.006) and had a longer delay in the beginning of cardiopulmonary resuscitation (8.3 vs 2.8 min.; p < 0.01). Mortality or severe neurological damage rate was higher in the group of those who had asystolia than in those with ventricular fibrillation in the first ECG (84% vs 55%), in those who arrived to the hospital unconscious (73.7% vs 15.4%) and in those who arrived in functional class IV (81% vs 16.6%). CONCLUSIONS: Up to 30% of the patients admitted after an episode of extrahospital cardiac arrest were discharged alive and without severe neurological damage. Advanced age, functional class IV and the delay of cardiopulmonary resuscitation are related to a unfavorable outcome.     

心肺复苏技能培训效果在心脏病患者家属与一般人群间的比较

目的:比较在社区居民不同对象进行心肺复苏技能培训的效果。方法:将心力衰竭(心衰)患者亲属作为亲属组,与一般人群组成的普通组(对照组)进行比较,两组人群经过同样培训后,进行相同的知识、技能考核,利用知识问卷分数、技能操作分数、生命体征判断正确率、心肺复苏操作准确率等观察指标进行培训效果评价。结果:亲属组各项指标均显著高于普通组(均P0.05)。结论:在社区人群急救培训中,组织者只有针对特定人群进行特定内容的教育与培训,才能达到应有的效果。     

Narrative review: cardiopulmonary resuscitation and emergency cardiovascular care: review of the current guidelines

Sudden cardiac death is a major clinical problem, causing 300,000 to 400,000 deaths annually and 63% of all cardiac deaths. Despite the overall decrease in cardiovascular mortality, the proportion of cardiovascular death from sudden cardiac death has remained constant. Survival rates among patients who have out-of-hospital cardiac arrest vary from 5% to 18%, depending on the presenting rhythm. The latest guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care published by the American Heart Association include substantial changes to the algorithms for basic life support and advanced cardiovascular life support. For unwitnessed cardiac arrest, immediate defibrillation of the patient is no longer recommended. Rather, 2 minutes of CPR before defibrillation is now recommended. People in cardiac arrest should no longer receive stacked shocks. The compression-ventilation ratio has been changed from 15:2 to 30:2. This article is a contemporary review of the management of CPR and emergency cardiovascular care. It examines current practice and data supporting use of CPR, along with changes in the management of sudden cardiac death.     

Factors modifying the effect of bystander cardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden.

AIM: To describe possible factors modifying the effect of bystander cardiopulmonary resuscitation on survival among patients suffering an out-of-hospital cardiac arrest. PATIENTS: A national survey in Sweden among patients suffering out-of-hospital cardiac arrest and in whom resuscitative efforts were attempted. Sixty per cent of ambulance organizations were included. DESIGN: Prospective evaluation. Survival was defined as survival 1 month after cardiac arrest. RESULTS: In all, 14065 reports were included in the evaluation. Of these, resuscitation efforts were attempted in 10966 cases, of which 1089 were witnessed by ambulance crews. The report deals with the remaining 9877 patients, of whom bystander cardiopulmonary resuscitation was attempted in 36%. Survival to 1 month was 8.2% among patients who received bystander cardiopulmonary resuscitation vs 2.5% among patients who did not receive it (odds ratio 3.5, 95% confidence interval 2.9-4.3). The effect of bystander cardiopulmonary resuscitation on survival was related to: (1) the interval between collapse and the start of bystander cardiopulmonary resuscitation (effect more marked in patients who experienced a short delay); (2) the quality of bystander cardiopulmonary resuscitation (effect more marked if both chest compressions and ventilation were performed than if either of them was performed alone); (3) the category of bystander (effect more marked if bystander cardiopulmonary resuscitation was performed by a non-layperson); (4) interval between collapse and arrival of the ambulance (effect more marked if this interval was prolonged); (5) age (effect more marked in bystander cardiopulmonary resuscitation among the elderly); and (6) the location of the arrest (effect more marked if the arrest took place outside the home). CONCLUSION: The effect of bystander cardiopulmonary resuscitation on survival after an out-of-hospital cardiac arrest can be modified by various factors. Factors that were associated with the effect of bystander cardiopulmonary resuscitation were the interval between the collapse and the start of bystander cardiopulmonary resuscitation, the quality of bystander cardiopulmonary resuscitation, whether or not the bystander was a layperson, the interval between collapse and the arrival of the ambulance, age and the place of arrest.     

急救站点与援助队在院内心肺复苏急救系统中应用

【】目的 探讨院内急救系统建立模式,提高抢救成功率,提升医护人员应急能力。方法 设置院内急救站点,组建援助急救队,采用突然模拟实战演练,寻找问题,不断改进,逐步建立院内心肺复苏系统。选择2016 年 5月-12月传统急救演练模拟心脏骤停患者39人次为对照组, 2017 年3月- 11月新设置急救演练模式后模拟心脏骤停患者42人次为干预组,分析两组院内急救首救医生到达救治点的时间(s)、开始心肺复苏时间(s)、高级生命支持到达时间(s)、除颤仪到达时间(s)。 结果 设置院内急救站点及援助急救队后,干预组首救医生到达救治点的时间为52.52±11.09s、开始心肺复苏时间为54.55±11.31s、高级生命支持到达时间为350.76±31.32s、除颤仪到达时间为379.33±35.12s,明显短于对照组,P ＜ 0.01,差异有统计学意义。结论 院内急救站点与援助急救队的设立, 显著缩短各环节急救时间,明显提升医务人员救治能力,充分调动团队救治速度,提升抢救成功率。建立急救管理新模式,定期实战演练,提升医院整体综合急救水平,是患者生命安全的重要保障措施之一。