心肺复苏低温治疗.ppt

Therapeutic hypothermia in Post–Cardiac Arrest Care 2015 VS 2010 hypoxemia ischemia reperfusion multiple organ systems 低温治疗的分类 低温治疗作用机制的新观念 降低脑的代谢水平，减低氧耗，改善并恢复能量供给； 抑制氧自由基产生，减轻氧化应激损伤； 下调炎症介质的产生和炎症细胞的集聚，减轻炎症损伤； 减低神经细胞及心肌细胞凋亡。 IntensiveCareMed.1996,22(11):1191-6. The 2010 Guidelines advised hypothermia duration temperature 12 to 24 hours The 2015 Guidelines advised hypothermia(32oC to 36oC)  2015 Guidelines advised hypothermia at least 24 hours （cerebral performance category，CPC）脑功能功能分类 敏感性较差 1. 好的脑功能： 有意识，灵敏，和能够工作并且正常生活。 可能有轻微心理或者神经病学缺陷(轻度的语言障碍，轻瘫或者轻微脑神经异常) . 2. 中度脑残疾： 有意识。在一保护的环境有足够脑功能胜任部分工作或者能进行独立日常生活活动(如穿，乘公共交通，食品准备). 这样的病人可能有半身不遂，发作，共济失调，构语障碍，言语障碍或者永久记忆或者精神变化 ?3.?严重脑残疾：有意识；因为受损的大脑功能病人依靠其他人得到日常帮助(在一个机构里或者在家需要特别的家庭帮助)?。至少已经有认知限制。这个种类包括大范围脑的不正常，病人能行走但是有严重的记忆混乱或者痴呆不能独立生存，那些全身瘫痪并且只能用眼睛交流的人，如同闭锁综合症。 4.?昏迷/植物的状态：没有意识，没意识到环境，没有认知。?没有文字和或心理与环境的相互作用。 5.?脑死亡。? JAMA.2006,295(1):50-57 Follow-up and Outcomes 序贯器官衰竭估计评分(SOFA) Cardiovascular component of Sequential Organ Failure Assessment score Day 1 to 3 Serious adverse events excluding death Patients were excluded due to exclusion criteria ? 13 known bleeding diathesis ? 15 suspected or confirmed acute intracranial bleeding ? 5 suspected or confirmed acute stroke Seizures might be preferred lower temperatures cerebral edema might be preferred lower temperatures Higher temperatures might be preferred in bleeding Rewarming maintain the body temperature After 28 hours, gradual rewarming to 37°C in hourly increments of 0.5°C was commenced in both groups. At 36 hours, mandatory sedation was discontinued or tapered. After the intervention period, the intention was to maintain the body temperature for unconscious patients below 37.5°C until 72 hours after the cardiac arrest, with the use of fever-control measures at the discretion of the sites.