廖晓星院外心脏骤停救治方法的新证据_培训课件.pptVIP

Company Logo Company Logo 治疗性亚低温 实现亚低温的方式 Cooling of the Body Surface Large Volume of Intravenous Cold fluids Intravascular Cooling Extracorporeal Membrane Oxygenation or Cardiopulmonary Bypass Transnasal Cooling System (Rhino Chill) Pharmacological Techniques Ice-Cold Perfluorocarbon Ventilation Lavage of Body Cavities Brain Cooling Cooling the Heart for the Intervention Hassan Soleimanpour,et al.Hypothermia after cardiac arrest as a noval approach to increase in cardiopulmonary cerebral resuscitation:a review.Iran Red Crescent Med,2014. Company Logo 治疗性亚低温 Company Logo 治疗性亚低温 现已公认，对于心脏骤停患者复跳后实施治疗性亚低温利大于弊 2005和2010指南均极力推荐 那么如果在院前急救使用亚低温是否也可进一步改善神经系统功能呢？ The hypothermia after cardiac arrest study group. Mild therapeutic hypotheutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med,2002, 346( 8):549-556. [24] Peberdy MA, Callaway CW, Neumar RW, et al;American Heart Association. Part 9: post-cardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation,2010,122(suppl 3):S768-S786 Company Logo 在一项纳入了1359名患者的临床随机对照试验中，院前复苏中对室颤或非室颤患者使用4度生理盐水2L静脉滴注后，深部体温较对照组可提前1个小时下降至34度，但最终生存率及神经功能恢复并无明显改善，且快速大量输注冷盐水可能增加24小时内再次心脏骤停和肺水肿的发生率 Table 7.Francis Kim, et al. Effect of Prehospital Induction of Mild HypothermiaonSurvival and Neurological Status Among Adults With Cardiac ArrestA Randomized Clinical Trial. JAMA,2014. 治疗性亚低温 Company Logo meta分析提示在院前使用低温治疗可更早达到亚低温状态，但未发现生存率提高 Fig 7. Mengyuan Diao, Fenglou Huang, Jun Guan,et al. Prehospital therapeutic hypothermia after cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Resuscitation, 2013. 治疗性亚低温 Company Logo 小结 现代心肺复苏在临床应用已经超过50年，统一的国际心肺复苏指南也已经实施了15个年头 虽然从流行病学和统计学的角度看，心肺复苏的成功率似乎没有明显提高，但其实许多研究资料包含了多种混杂因素，比如心肺复苏的对象主要是原发性心脏骤停，而临床实际中却包括了有各种器质性病变的患者，甚至临终状态，从而影响了结论的客观性 Company Logo 小结 自2000年采用全球统一的心肺复苏指南以来，在理论体系和实用技术上均有新的突破 作为临床医