Wright Wendy L, Geocadin Romergryko G
Departments of Neurology and Neurosurgery, Emory University Hospital, Atlanta, Georgia, USA.
Semin Neurol. 2006 Sep;26(4):396-402. doi: 10.1055/s-2006-948320.
Cardiac arrest is a common disease in the United States, and many patients will die as a result of the neurological damage suffered during the anoxic period, or will live in a neurologically debilitated state. When cardiopulmonary-cerebral resuscitation results in the return of spontaneous circulation, intensive care is required to optimize neurological recovery. Such "brain-oriented" therapies include routine care, such as positioning and maintenance of volume status; optimization of cerebral perfusion, with the use of vasopressors if needed; management of increased intracranial pressure with agents such as hypertonic saline; assuring adequate oxygenation and avoiding hypercapnia; aggressive fever control; intensive glucose control, with the use of an insulin drip if needed; and management of seizures if they occur. To date, no neuroprotectant medications have been shown to improve neurological outcome. Induced moderate therapeutic hypothermia is utilized as a neuroprotective maneuver. Future treatment options and advanced monitoring techniques are also discussed. Further study to optimize neuroprotective strategies when treating patients who survive cardiac arrest is needed.
心脏骤停在美国是一种常见疾病，许多患者会因缺氧期遭受的神经损伤而死亡，或者会处于神经功能衰弱的状态存活。当心肺脑复苏使自主循环恢复时，需要重症监护以优化神经功能恢复。此类“以脑为导向”的治疗方法包括常规护理，如体位摆放和维持血容量状态；优化脑灌注，必要时使用血管升压药；使用高渗盐水等药物处理颅内压升高；确保充分氧合并避免高碳酸血症；积极控制发热；强化血糖控制，必要时使用胰岛素静脉滴注；以及处理癫痫发作（如果发生）。迄今为止，尚无神经保护药物被证明能改善神经功能结局。诱导性中度治疗性低温被用作一种神经保护手段。文中还讨论了未来的治疗选择和先进的监测技术。需要进一步研究以优化治疗心脏骤停存活患者时的神经保护策略。
