心脏骤停并发症的预防和处理_课件.pptVIP

CA患者复苏后并发症的预防及处理 心脏骤停后的心肌损害 1 心脏骤停后的脑损害 2 全身性缺血/再灌注损伤 3 持续性病理状态 4 持续性病理状态 导致或促发心脏骤停的、尚未消除的各种原有病症（或病因），诸如急性冠脉综合症、肺部疾病、脓毒症、出血以及各种中毒（毒物或药物过量）等。原有病症本身就很复杂，而在心脏骤停后的诊断与治疗更为困难。 持续性病理状态 寻找疾病的具体病因针对性治疗 展 望 如何提高心脏骤停后心肺复苏的成功率是国内外研究的难点和重点，尤其是在心肺复苏初步成功后如何改善患者的预后更是临床亟待解决的难题，若能给予及时、正确、有效的处理，则可望降低患者的死亡率和病残率。 Thank you for your attention! In February, 2002 two major landmark studies were published in the New England Journal of Medicine. 2002年2月，两个划时代研究发表在新英格兰医学杂志上 They both involved therapeutic hypothermia after cardiac arrest. The first one was done out of Europe – it’s called HACA (Hypothermia After Cardiac Arrest). 两篇都是涉及心脏停搏后的亚低温治疗。第一个出自欧洲-叫做haca The other one came out of Australia, the Principal Investigator, Stephen Bernard, performed a similar trial to cool patients after cardiac arrest and compare cardiac arrest patients who were not cooled. 另一个出自澳洲，主要研究人员Stephen Bernard，做了一个配对试验：心脏停搏后对患者冷却和不冷却的临床比较 We have done a feasibility study was published in the Resuscitation using the Icy Catheter after cardiac arrest, which a prospective, multi-center pilot trial on the feasibility可行性 and safety安全性 and we will pass that out to you. 我们也做了一个可行性研究发表了，心脏停搏后使用icy导管，是一个前瞻性，多中心操控的试验主要对于可行性和安全性的试验。 This led to the ILCOR Guideline. ILCOR is an international group including the AHA and European Resuscitation Council and equivalent to Japan and all over the world. ILCOR的指导。 ILCOR是一个国际组织包括AHA和欧洲复苏委员会和日本及全球 They published an advisory statement where they provide new guidelines for how cardiac arrest patients should be treated. This advisory statement replicates the conclusion from the 2 trials…that unconscious adult patients that get return of spontaneous circulation should be cooled between 32°C to 34°C for 12 to 24 hours. And that this will have benefit in all rhythms not just VF and for both in and out of hospital cardiac arrest. 他们发表了忠告声明，新的指南用于如何治疗心脏停搏患者。这个忠告主要来自前面说的两个试验…, 对于无意识的成年患者一旦恢复了自主循环就应该把体温降到32-34度之间，12-24小时，这将对所有心律失常的患者而不仅仅是室颤的患者并且无论是门诊患者还是住院患者。 Here are his 6