心肺脑复苏成功9例报告

报告9例因电击、休克、缺氧、迷走神经反射、颅压增高引起的循环骤停复苏成功的经验。在初步救生措施(BLS)阶段,重点是心肺复苏,但要及早采取保护脑组织的措施;在进一步心脏救生措施(ACLS)阶段,以维持循环功能和脑复苏为主,并要防治多系统器官功能的衰竭。     

BrdU-ELISA法测定四逆汤及组方药提取物对大鼠血管平滑肌细胞增殖的影响

目的 观察四逆汤(SNT)及组方药提取物对大鼠主动脉血管平滑肌细胞(VSMC)增殖的影响。方法 采用MTT比色法和Brdu—ELISA法观察药物对离体大鼠VSMC增殖的影响。结果 BrdU—ELISA法结果表明四逆汤总提取物(EST)对VSMC的BrdU掺入DNA没有显著影响，而MTT测定表明：EST可以提高VSMC的脱氢酶活性。甘草(LE)、附子(AE)、干姜(GE)、甘草加附子(LAE)、干姜加附子(AGE)提取物显著提高VSMC的脱氢酶活性，同时提高VSMC的BrdU掺入DNA的水平。结论 EST可以增加VSMC的脱氢酶活性，但对VSMC的BrdU掺入DNA的水平无影响。而其他组方药提取物可以增加VSMC的脱氢酶活性，同时提高VSMC的BrdU掺入DNA的水平。     

Instructional design dogma: Creating planned learning experiences in simulation

Human lives depend on the performance of our trainees; thus, the educational methodology used to transform our learners into experts are of paramount importance. Effective use of simulation requires educators explore and apply educational theory as they discover who the learner is, how the learner learns, what the learning needs are, and which planned learning experiences are best suited to meet the learner's specialized needs. The purpose of this article is to portray simulation as an educational strategy in the context of a curriculum, to explore emerging theories from educational psychology, and to provide concrete examples of their application in simulation-based education.     

主动按压减压结合高频喷射通气用于犬的心肺复苏

目的　评价主动按压减压结合高频通气 (ACD- H)用于心肺复苏的可行性。方法　ACD- H:按压减压与通气同时进行 ,按压与呼气同步 ,减压与吸气同步 ;而主动按压减压结合传统通气技术 (ACD- C) :按压减压连续 5次停 2秒进行一次通气。 9只犬吸入 10 5℃蒸气 4秒致伤后用以上方法复苏。结果　心搏骤停前观察 :ACD- H吸气流速峰值 7.32 L / m in,呼气流速峰值 9.5 0 L / min;潮气量 79.5 0 ml,每分通气量 7.9L / m in,Pa O2 2 2 .2 5 k Pa,Pa CO2 4.93k Pa,明显优于主动按压减压结合持续供氧 (ACD) ,也明显优于单纯的 HFJV及主动按压 (AC)。电致颤心搏骤停后 ,按压与提拉条件不变 ,观测循环指标 :动脉收缩压最低值 ACD- C为 0 ,ACD- H为 18.6 8k Pa,平均值 ACD- C为19.0 7k Pa,ACD- H为 2 2 .81k Pa,两者有非常显著差异 ;心排血量最低值 ACD- C为 0 ,ACD- H为 (0 .81± 0 .45 ) L / min,平均值 ACD- C为 (0 .6 5± 0 .14) L / m in,ACD- H为 (0 .92± 0 .33) L / m in,两者差异非常明显。结论　 ACD- H用于心肺复苏 ,其效果尤于传统方法。     

Resuscitation outcomes comparing year 2000 with year 2005 ALS guidelines in a pig model of cardiac arrest

BACKGROUND: Ventricular fibrillation remains the leading cause of death in western societies. International organizations publish guidelines to follow in case of cardiac arrest. The aim of the present study is to assess whether the newly published guidelines record similar resuscitation success with the 2000 Advanced Life Support Guidelines on Resuscitation in a swine model of cardiac arrest. METHODS AND RESULTS: Nineteen landrace/large white pigs were used. Ventricular fibrillation was induced with the use of a transvenous pacing wire inserted into the right ventricle. The animals were randomized into two groups. In Group A, 10 animals were resuscitated using the 2000 guidelines, whereas in Group B, 9 animals were resuscitated using the 2005 guidelines. Both algorithms recorded similar successful resuscitation rates, as 60% of the animals in Group A and 44.5% in Group B were successfully resuscitated. However, animals in Group A restored a rhythm, compatible with a pulse, quicker than those in Group B (p=0.002). Coronary perfusion pressure (CPP) was not adversely affected by three defibrillation attempts in Group A. CONCLUSIONS: Both algorithms' resulted in comparable resuscitation success, however, guidelines 2000 resulted in faster resuscitation times. These preliminary results merit further investigation.     

Strict versus moderate glucose control after resuscitation from ventricular fibrillation

OBJECTIVE: Elevated blood glucose is associated with poor outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Our aim was to determine whether strict glucose control with intensive insulin treatment improves outcome of OHCA patients. DESIGN: A randomized, controlled trial. SETTING: Two university hospital intensive care units. PATIENTS: Ninety patients resuscitated from OHCA with ventricular fibrillation detected as the initial rhythm were treated with therapeutic hypothermia. INTERVENTIONS: Patients were randomized into two treatment groups: a strict glucose control group (SGC group), with a blood glucose target of 4-6 mmol/l, or a moderate glucose control group (MGC group), with a blood glucose target of 6-8 mmol/l. Both groups were treated with insulin infusion for 48 h, because a control group with no treatment was considered unethical. MEASUREMENTS AND RESULTS: Baseline data were similar in both groups. In the SGC group 71% of the glucose measurements were within the target range compared with 41% in the MGC group. Median glucose was 5.0 mmol/l in the SGC group and 6.4 mmol/l in the MGC group. The occurrence of moderate hypoglycemic episodes was 18% in the SGC group and 2% in the MGC group (p = 0.008). No episodes of severe hypoglycemia occurred. Mortality by day 30 was 33% in the SGC group and 35% in the MGC group (p = 0.846); the difference was 2% (95% CI -18% to +22%). CONCLUSIONS: We found no additional survival benefit from strict glucose control compared with moderate glucose control with a target between 6 and 8 mmol/l in OHCA patients.     

Hyperthermia following cardiopulmonary resuscitation

To clarify the clinical nature of post-resuscitation hyperthermia, we reviewed the charts of 18 patients who had cardiac arrest on arrival and regained cardiovascular stability for a study period of sufficient length. Patients with trauma, burns, poisoning and cerebrovascular accidents were excluded. We analyzed the hyperthermia (above 38°C) occurring in the initial 48 h after resuscitation. After resuscitation, most patients showed a rapid rise in body temperature. Patients with later brain death showed significantly earlier appearance of hyperthermia (6.2 h after cardiac resuscitation; median) and a higher peak temperature (39.8°C; median) compared with patients showing prolonged coma (12.7 h and 38.3°C, respectively). Hyperthermia above 39°C was associated with subsequent brain death. The incidence of factors influencing body temperature did not differ between the brain death and prolonged coma groups. Patients achieving full recovery did not show hyperthermia. In conclusion, hyperthermia is an early indicator of brain damage after resuscitation.No financial support was given to this study     

危重症患儿父母对复苏陪伴的态度及其影响因素分析

目的探讨危重症患儿父母对复苏陪伴的态度及影响因素,旨在为改善患儿及家属在复苏过程的体验提供科学依据。方法采用横断面调查的方法,方便抽样选取郑州大学附属儿童医院2018年8月—2019年8月住院的危重症患儿父母为研究对象,采用一般资料调查表、家属版复苏陪伴利弊评估量表(FPDR-BRS)对危重症患儿父母对复苏陪伴的态度进行调查,并分析其影响因素。共发放问卷200份,回收有效问卷189份,有效回收率为94.5%。结果189名危重症患儿父母FPDR-BRS总分为(74.75±22.54)分;单因素分析显示,危重症患儿父母FPDR-BRS总分在与患儿的关系、父母职业、文化水平、有无复苏经历方面差异有统计学意义(P<0.05);多重线性回归分析显示,与患儿的关系、父母职业和文化水平是复苏陪伴态度的影响因素(P<0.05)。结论危重症患儿父母对复苏陪伴的认同度处于中等水平,与患儿的关系、父母职业和文化水平是影响复苏陪伴态度的因素,医护人员应根据复苏陪伴态度的影响因素制订针对性的干预措施以改善患儿及家属在复苏过程中的体验。     

脓毒性休克的复苏与多器官功能障碍综合征早期防治的研究

目的：评价修改后的复苏方案对脓毒性休克及多器官功能障碍综合征（MODS）的防治效果。方法：总结1995年3月至2001年8月收治的脓毒性休克患者87例，对比分析修改后的方案与旧方案治疗脓毒性休克的疗效及MODS的发生率与病死率。修改后的方案主要是及时、快速、充分液体复苏，应用血管活性药物改善脏器灌注，氧自由基清除剂减少自由基损害，早期开展肠道内营养保护肠黏膜屏障。结果：采用新方案明显缩短了休克的纠正时间，降低了血浆中内毒素与肿瘤坏死因子（TNF）的水平，减少了MODS的发生率与病死率。结论：修改后的复苏方案显著提高了复苏效率，有助于减少或消除MODS诱因，可显著降低MODS的发病率与病死率。