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【JACC】心肺复苏最新进展---心脑复苏

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Title: Recent Advances in Cardiopulmonary Resuscitation: Cardiocerebral Resuscitation
Topic: Arrhythmias
Date Posted: 1/23/2009
Author(s): Ewy GA, Kern KB.
Citation: J Am Coll Cardiol 2009;53:149-157.
Clinical Trial: No

Perspective: The following are 10 points to remember from this review of cardiocerebral resuscitation (CCR):

1. The first step of CCR for witnessed cardiac arrest is continuous chest compressions (CCCs) without mouth-to-mouth or mechanical ventilation.

2. If an automated external defibrillator is available within 4-5 minutes of the onset of a ventricular fibrillation (VF) arrest, a shock should be promptly delivered.

3. After the first 5 minutes of VF arrest, because myocardial energy stores are depleted and attempts at electrical defibrillation typically result in asystole or pulseless electrical activity (PEA), defibrillation should be preceded by 200 CCCs.

4. After several minutes of VF, defibrillation often is followed by asystole or PEA and therefore 200 CCCs should be administered immediately post-shock, without a pause to assess the rhythm.

5. Any form of positive-pressure ventilation is deleterious during cardiac arrest because the increase in intrathoracic pressure decreases venous return to the heart and perfusion of the heart and brain.

6. Mouth-to-mouth 搑escue breaths?also are deleterious because they dissuade bystanders from performing cardiopulmonary resuscitation (CPR) and necessitate a pause in CCCs.

7. Instead of assisted ventilation, the airway should be opened with an oropharyngeal device and a non-rebreather mask should be used to deliver high-flow oxygen for passive oxygen insufflation.

8. CCR is not appropriate for patients with a respiratory arrest, because such patients require assisted ventilation as quickly as possible.

9. Hypothermia is appropriate for patients who are comatose post-resuscitation.

10. Compared to conventional CPR, CCR has been shown to improve survival to hospital discharge after out-of-hospital cardiac arrest by a factor of 2.7-3.7.

http://www.ncbi.nlm.nih.gov/pubmed/19130982?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T18-4V9XHDX-2&_user=3192114&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059499&_version=1&_urlVersion=0&_userid=3192114&md5=c2161390ea3d6aef6f2e0c0599479d9d

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2009-02-06 08:42 浏览 : 4618 回复 : 22

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• 浙一咋了？？爆炸了？？？

chenxi_ccr

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本人认领，如8 小时后未上传请其他战友认领。

2009-02-27 16:55

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• 综合医院全科门诊中乏力患者特征及就诊原因分析

chenxi_ccr

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Perspective: The following are 10 points to remember from this review of cardiocerebral resuscitation (CCR):
应该记住下面这篇有关心脑复苏的综述中提到的十点。
1. The first step of CCR for witnessed cardiac arrest is continuous chest compressions (CCCs) without mouth-to-mouth or mechanical ventilation.
1.在有病人心脏停跳后进行心脑复苏首先是持续胸外按压，而不是口对口呼吸或是机械通气。
2. If an automated external defibrillator is available within 4-5 minutes of the onset of a ventricular fibrillation (VF) arrest, a shock should be promptly delivered.
2.一个病人发生心室纤颤的四五分钟内，如果有条件进行体外自动颤，应该迅速进行除颤。
3. After the first 5 minutes of VF arrest, because myocardial energy stores are depleted and attempts at electrical defibrillation typically result in asystole or pulseless electrical activity (PEA), defibrillation should be preceded by 200 CCCs.
3.在发生心室纤颤五分钟后，由于心肌能量储备的耗竭，电除颤常常导致心跳停顿或是心电机械分离，因此，要将持续胸外按压放在除颤之前。
4. After several minutes of VF, defibrillation often is followed by asystole or PEA and therefore 200 CCCs should be administered immediately post-shock, without a pause to assess the rhythm.
4.心室纤颤几分钟后，除颤后常常出现心跳停顿或是心电机械分离，因此，除颤后应立即进行持续胸外按压，而不应该等待观察心脏复律情况。
5. Any form of positive-pressure ventilation is deleterious during cardiac arrest because the increase in intrathoracic pressure decreases venous return to the heart and perfusion of the heart and brain.
5.在心脏停跳期间，任何形式的正压通气都是有害的。因为正压通气会提高胸内压，减少静脉回流，进而减少心脑血液灌注。
6. Mouth-to-mouth 搑escue breaths?also are deleterious because they dissuade bystanders from performing cardiopulmonary resuscitation (CPR) and necessitate a pause in CCCs.
6.口对口呼吸也是有害的。因为进行心肺抢救患者的人员需要停止持续胸外按压，（而行口对口呼吸）
7. Instead of assisted ventilation, the airway should be opened with an oropharyngeal device and a non-rebreather mask should be used to deliver high-flow oxygen for passive oxygen insufflation.
7.不应该进行辅助通气，而是应该使用开口器械保持气道通畅。并且使用非再生式氧气面罩给予高流量氧气吹送。
8. CCR is not appropriate for patients with a respiratory arrest, because such patients require assisted ventilation as quickly as possible.
8.心脑复苏并不适合呼吸骤停的病人。这类病人首先需要尽快辅助通气。
9. Hypothermia is appropriate for patients who are comatose post-resuscitation.
9.处于昏迷的复苏后综合征病人，（控制性）低温是适宜的。
10. Compared to conventional CPR, CCR has been shown to improve survival to hospital discharge after out-of-hospital cardiac arrest by a factor of 2.7-3.7
10.与常规心肺脑复苏比相，心脑复苏提高了在院外发生心跳骤停患者的生存康复出院率。大约可以提高2.7到3.7个基点。

2009-02-27 17:37