特殊情况下的CPR摘要.ppt

CPR in Special Situations特殊情况下的CPR 福建医科大学附属协和医院麻醉科 翁险峰 ACLS in the Perioperative Period围术期高级心脏生命支持 Causes of cardiac arrest + 心跳骤停的原因 1) intraoperative hemorrhage 术中出血 2) pre-existent cardiac pathology 原有的心脏疾患 3) hypoxia, both at intubation or extubation 插管或拔管时缺氧. a different milieu of pathophysiology病理生理的不同之处 Hypovolemia, as a cause of myocardial ischemia, is far more common than transmural infarction from plaque rupture.术中低血容量导致的心肌缺血远多于透壁心梗。 The most common cardiac dysrrythmia during general and neuraxial anesthesia is bradycardia followed by asystole (45%).全麻和椎管内麻醉中最常见的心律失常是心动过缓之后的心跳停止。 The other life threatening cardiac rhythms are severe tachydysrrhythmias including ventricular tachycardia（VT), ventricular fibrillation (VF 14%), and pulseless electrical activity (PEA 7%).其它威胁生命的心律失常是严重的频速型心律失常，包括室性心动过速，室颤，和无脉性电活动。 hyperventilation is almost invariablyassociated with worsened survival过度通气常与糟糕的生存预后相关 in a low flow state the duration of increased intrathoracic pressure is proportional to the ventilation rate and inversely proportional to blood pressure, coronary and cerebral perfusion胸内压的增加与通气频率成正比，与血压及冠脉、脑血管灌注成反比。 Recent versions of the ACLS guidelines have recommended lower levels of ventilatory support.近期的高级生命支持指南推荐低水平的通气支持。 Ventilation at 20 breaths a minute is associated with significantly lower survival than ventilation at 12 breaths/minute. 每分钟20次的通气频率与每分钟12次通气频率相比，生存率低 Cardioversion心脏复律 Immediate cardioversion is indicated for a patient with serious signs symptoms related to the tachycardia or if ventricular rate is 150 bpm伴有严重症状的心动过速或心室率 150次/分，是立即心脏复律的指征。 Always be prepared to externally pace patients who are being cardioverted, as some will convert into a very bradycardic rhythm.对心脏复律的患者应准备好体外起搏，这是由于一些患者会出现严重的心动过缓。 Avoiding cardiac arrest requires successfully managing acute anemia, hypoxemia, and all contributing factors to cardiac output: preload, contractility, and afterload.要避免心跳骤停，应处理好急性贫血、低氧血症及与心输出量有关的心脏前负荷、心肌收缩力、心脏后负荷。 Common Causes of AC