Ragoschke-Schumm A, Pfeifer R, Marx G, Knoepffler N, Witte O W, Isenmann S
Institut für Diagnostische und Interventionelle Radiologie, Jena, Germany.
Nervenarzt. 2007 Aug;78(8):937-43. doi: 10.1007/s00115-007-2286-0.
The developments of cardiopulmonary resuscitation and intensive care medicine have made possible survival after cardiac arrest. However, only 10-30% of patients with initially successful resuscitation later reach a state without severe neurological impairment. Ethical and socioeconomic reasons therefore make early prognosis important for certain patients. There are no reliable parameters for predictions of good clinical outcome. If clinical information is consistent with severe hypoxic brain damage, cortical somatosensory evoked potentials are absent, and neuron-specific enolase values exceed 33-65 microg/l, recovery of consciousness can be excluded. The same result can be predicted if brain imaging shows severe hypoxemic changes or if a myoclonic status occurs on the first day. In summary, the prognosis in patients with cerebral anoxy and cardiopulmonary resuscitation remains poor. Treatment with hypothermia for 24 h is recommended.
心肺复苏和重症监护医学的发展使心脏骤停后存活成为可能。然而，最初复苏成功的患者中只有10% - 30%后来能达到无严重神经功能障碍的状态。因此，出于伦理和社会经济原因，早期预后对某些患者很重要。目前尚无可靠的参数来预测良好的临床结局。如果临床信息与严重缺氧性脑损伤一致、皮层体感诱发电位缺失且神经元特异性烯醇化酶值超过33 - 65微克/升，则可排除意识恢复的可能。如果脑部影像学显示严重的低氧改变或在第一天出现肌阵挛状态，也可预测到同样的结果。总之，脑缺氧和心肺复苏患者的预后仍然很差。建议进行24小时低温治疗。
