心肺复苏低温治疗PPT.ppt

Therapeutic hypothermia in Post–Cardiac Arrest Care;心脏骤停的流行病学 ; ;低温治疗的分类;低温治疗作用机制的新观念;适应症;Bladder Temperature in the Normothermia and Hypothermia Groups. The T bars indicate the 75th percentile in the normothermia group and the 25th percentile in the hypothermia group. The target temperature in the hypothermia group was 32℃ to 34 ℃, and the duration of cooling was 24 hours. Only patients with recorded temperatures were included in the analysis. N Engl J Med. 2002, 346(8): 557-563. ;After 6 months: 75 of the 136 (55%) in hypothermia group had better favorable neurologic outcome than normothermia group (39%).;After 6 months: Rate of death (41%) in the hypothermia is 14% lower than in the normothermia group (55%). ;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;?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;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 ;rebound hyperthermia;Avoidance of Hyperthermia fever ;Association of rebound hyperthermia with mortality;Risk factors for rebound hyperthermia;The presence of rebound hyperthermia is associated with anincreased risk of in-hospital mortality. 40 of the 99 (40.4%) patients without rebound