特殊病理生理条件下的心肺复苏——-2015年美国心脏协会心肺复苏与心血管急救指南更新解读

背景 在临床工作中我们常常需要对一些处在特殊病理生理状态下的患者进行心肺复苏.目的 通过解读2015年美国心脏协会心肺复苏与心血管急救指南更新相关部分,提高对相关患者的心肺复苏能力.内容 妊娠状态下的心肺复苏注意体位,母体复苏失败时及时进行剖宫产术.肺栓塞引起的心搏骤停,疑似或确诊的病例都可以进行早期溶栓术,对于确诊的病例还可以经行手术取栓.阿片类药物过量导致心搏骤停,可以首先使用纳洛酮治疗,并同时开始心肺复苏术.局部麻醉药中毒引起心搏骤停,在心肺复苏同时可以使用脂肪乳剂配合抢救.冠状动脉介入治疗术中发生的心搏骤停,应及时进行体外心肺复苏.趋向 用手将子宫向左推移以减轻低血压产妇下腔静脉所受的妊娠子宫施加的压力,缺乏相关文献证实,且对产妇围死亡期剖宫产的时机选择也未有定论.疑似肺栓塞造成心搏骤停患者溶栓治疗是否纳入治疗的标准仍有争议.在某些情况下,静脉脂肪乳剂可以加强肾上腺素和垂体后叶素的疗效,得到了动物研究的证实,但缺乏人类实验数据支持.

Cardiopulmonary resuscitation under special pathophysiological conditions: an update of the American Heart Association cardiopulmonary resuscitation and cardiovascular emergency guidelines-2015

Background In clinical work,we often need to perform cardiopulmonary resuscitation in some patients with special pathophysiology.Objective By interpreting the 2015 American Heart Association cardiopulmonary resuscitation and cardiovascular emergency guidelines to update the relevant parts,improve the ability of patients with cardiopulmonary resuscitation.Content Cesarean section in pregnant women with cardiopulmonary resuscitation with attention to the failure of maternal recovery.Pulmonary embolism caused by cardiac arrest,suspected or confirmed cases of early thrombolysis can be carried out,and the diagnosis of cases can also be treated by surgical thrombectomy.Opioid overdose can lead to cardiac arrest,which can be treated with naloxone and cardiopulmonary resuscitation at the same time.Local anesthetics poisoning caused by cardiac arrest during cardiopulmonary resuscitation can be used simultaneously with the rescue of fat emulsion.Cardiopulmonary resuscitation in patients with sudden cardiac arrest during percutaneous coronary intervention.Trends The lack of relevant literature confirms that the pressure of the inferior vena cava in the lower abdomen of the maternal is reduced by hand to the left of the uterus to reduce hypotension.And there is no conclusion about the timing of cesarean section for women.The standard for the treatment of patients with cardiac arrest caused by suspected pulmonary embolism is still controversial.In some cases,intravenous fat emulsions may enhance the efficacy of epinephrine and vasopressin,which has been confirmed by animal studies,but not supported by experimental data.The above aspects are the direction of our future exploration.