Püttgen H Adrian, Geocadin Romergryko
Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Neurol Sci. 2007 Oct 15;261(1-2):108-17. doi: 10.1016/j.jns.2007.04.041. Epub 2007 Jun 13.
Because a large number of patients will suffer cardiac arrest each year, physicians must place attention on improving care for patients in the post-resuscitative setting. Part of this effort requires setting realistic goals based on patients' potential for recovery. Recovery from cardiac arrest often depends on the extent of anoxic brain injury, and for this reason primary teams consult neurologists to offer insight into potential for awakening from post-arrest coma. In doing so, neurologists inform a decision with legal, social and ethical implications. Though inapplicable without preparation at the time of cardiac arrest, the four principles of medical ethics have a direct impact on decision making during the post-resuscitative period. A review of the literature reveals that physical examination, electrophysiology, radiology, and biochemical markers can prove useful in estimating a patient's chances for neurological recovery from cardiac arrest. These factors most reliably predict poor outcome, but do so with high specificity. However, the role of the neurology consultant must change to include guidance on strategies of neuroprotection. Aggressive efforts directed towards neuroprotection may change predictions for outcomes after cardiac arrest in the future.
由于每年有大量患者会发生心脏骤停，医生必须重视改善对复苏后患者的护理。这项工作的一部分需要根据患者的恢复潜力设定现实的目标。心脏骤停后的恢复通常取决于缺氧性脑损伤的程度，因此，主要治疗团队会咨询神经科医生，以深入了解患者从心脏骤停后昏迷中苏醒的可能性。在这样做的过程中，神经科医生会为一个具有法律、社会和伦理意义的决定提供信息。虽然在心脏骤停发生时未经准备就不适用，但医学伦理的四项原则对复苏后阶段的决策有直接影响。文献综述表明，体格检查、电生理学、放射学和生化标志物有助于评估患者从心脏骤停中神经功能恢复的可能性。这些因素最可靠地预测不良结果，但具有很高的特异性。然而，神经科会诊医生的角色必须改变，包括提供神经保护策略的指导。积极的神经保护措施可能会改变未来心脏骤停后结果的预测。
