Craddock L, Miller B, Clifton G, Krumbach B, Pluss W
Abe Ravin Division of Cardiovascular Medicine, Rose Medical Center, Denver, Colorado 80220.
J Emerg Med. 1991 Nov-Dec;9(6):469-76. doi: 10.1016/0736-4679(91)90220-a.
We present evidence of resuscitation from prolonged (70-min) cardiac arrest, temporally associated with administration of 8 g intravenous (IV) magnesium sulfate (MgSO4). A patient undergoing liposuction surgery developed bradycardia and a fall in oxygen tension after reversal of general anesthesia with physostigmine. The electrocardiogram (ECG) rhythm degenerated to ventricular asystole, which was refractory to standard therapy, including multiple boluses of epinephrine, atropine, wide-open dopamine, and attempts at right heart pacing. External cardiopulmonary resuscitation (CPR) was continuously maintained with the patient intubated on 100% oxygen. Multiple electric countershocks (x7) and lidocaine were also administered when ventricular tachycardia/ventricular fibrillation (VT/VF) occurred, but without clinical success. Approximately one hour into the resuscitation, after all of the above occurred, 8 g IV MgSO4 was given and countershock repeated. Whereas the 7 previous countershocks had resulted in unsuccessful conversion of VT/VF to a pulseless rhythm (EMD), the 8th countershock (applied immediately after two 4 g boluses of IV MgSO4) resulted in a stable pulse and normal sinus rhythm developing within 4 minutes. The patient recovered without neurologic deficit.
我们提供了因长时间(70分钟)心脏骤停复苏成功的证据,复苏时间与静脉注射8克硫酸镁(MgSO4)相关。一名接受吸脂手术的患者在用毒扁豆碱逆转全身麻醉后出现心动过缓和氧分压下降。心电图(ECG)节律恶化为心室停搏,对包括多次推注肾上腺素、阿托品、大剂量多巴胺以及右心起搏尝试在内的标准治疗均无效。患者插管并吸入100%氧气的情况下持续进行体外心肺复苏(CPR)。发生室性心动过速/心室颤动(VT/VF)时还进行了多次电击除颤(7次)并给予利多卡因,但未取得临床成功。在复苏大约一小时后,在上述所有情况发生之后,静脉注射了8克硫酸镁并再次进行除颤。尽管之前的7次除颤未能将VT/VF转为无脉性节律(电机械分离),但第8次除颤(在两次静脉注射4克硫酸镁后立即进行)在4分钟内使患者出现稳定脉搏并恢复正常窦性心律。患者康复且无神经功能缺损。