课件：心脏骤停后综合征.ppt

脑复苏的结局 GPS(Glasgow-Pittsburg )分级: 1级: 脑及总体情况优良:清醒、健康、思维清晰、 能从事工作和正常生活，可能有轻度神经及精神障碍 2级: 轻度脑和总体残废：清醒、可自理生活，能在有保护的环境下参加工作，或伴有其他系统的中度功能残废，不能参加竞争性工作 3级:中度脑和总体残废：清醒、但有脑功能障碍，依赖旁人料理生活，轻者可自行走动，重者痴呆功瘫痪 4级:植物状态（或大脑死亡）: 昏迷、无神志、对外界无反应，可自动睁眼或发声，无大脑反应，呈角弓反张状 GPS-5级:脑死亡: 无呼吸、无任何反射，脑电图呈平线 进 展 目前仍遵照2010CPR指南 A-B-C改为C-A-B 如何提高心肺复苏的救治成功率 美国心脏病学会于2013年制定了提高心肺复苏质量的共识，涉及4方面内容： 1.复苏小组心肺复苏质量的评价指标 2.如何监测和反馈，包括患者对复苏的反应、团队的表现 3.如何保证复杂环境下高质量的心肺复苏 4.心肺复苏的持续质量改进 Circulation,2013,128(4):417-435 如何提高心肺复苏的救治成功率 胸外按压分数（chest compression fraction,CCF,指发现心脏骤停到自主循环恢复的整个过程中胸外按压时间的比值）80% 胸外按压频率100~200次/分 成人按压深度50mm(避免倾斜，婴幼儿和儿童按压深度不少于胸廓前后径的1/3) 避免过度通气（只需轻轻的胸廓抬起，呼吸频率12次/分） 如何提高心肺复苏的救治成功率 气管插管在院前急救中是否绝对必要仍无定论 肾上腺素可能增加心肌功能障碍，干扰大脑微循环，对患者存活率不利。与指南建议的4~5min给药时间比较，肾上腺素给药时间间隔越长，复苏患者出院存活率越高 胸外按压设备与徒手哪个好？（ Anyone, anywhere, can now initiate cardiac resuscitative procedures,All that needed are two hands。施救者的双手永远是第一首选!） Methods: A prospective cohort of adult comatose CA patients treated with TH (33°C, for 24h) admitted to the medical/surgical intensive care unit, Lausanne University Hospital, was studied. Serum PCT was measured early after CA, at two time-points (days 1 and 2). The SOFA score was used to quantify the severity of PCAS. Diagnosis of early-onset infections (within the first 7 days of ICU stay) was made after review of clinical, radiological and microbiological data. Neurological recovery at 3 months was assessed with Cerebral Performance Categories (CPC), and was dichotomized as favorable (CPC 1-2) vs. unfavorable (CPC 3-5). Conclusion:Early elevations of serum PCT levels correlate with the severity of PCAS and are associated with worse neurological recovery after CA and TH. In contrast, elevated serum PCT did not correlate with early-onset infections in this setting. Methods:Retrospective study of consecutive patients admitted to a single academic intensive care unit (ICU) for out-of-hospital cardiac?arrest(betw