Berg Marc D, Nadkarni Vinay M, Berg Robert A
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Member Steele Memorial Research Center, The University of Arizona College of Medicine, Tucson, Arizona 85724, USA.
Curr Opin Crit Care. 2008 Jun;14(3):254-60. doi: 10.1097/MCC.0b013e3282fa6fec.
To summarize current opinion and advances in pediatric cardiopulmonary resuscitation, including etiology, pathophysiology, rationale for interventions, and postresuscitation management.
Cardiac arrest and ventricular fibrillation in children are not as uncommon as previously reported. Out-of-hospital cardiac arrests occur in 8-20 children/100,000/year, and in-hospital arrests occur in 2-6% admitted to a pediatric intensive care unit. Most pediatric arrests are precipitated by asphyxia or circulatory shock, but approximately 10% are precipitated by ventricular tachycardia or fibrillation. In addition, greater than 1/4 of children with in-hospital cardiac arrests have ventricular tachycardia or fibrillation at some time during the event. After out-of-hospital arrests, approximately 10% survive to hospital discharge, whereas greater than 25% survive to discharge after in-hospital arrests. Appropriate interventions differ during the four phases of cardiac arrest: prearrest, no-flow, low-flow, and postresuscitation. Close monitoring and prompt cardiopulmonary resuscitation can minimize the no-flow phase, good quality cardiopulmonary resuscitation is important during the low-flow phase, defibrillation is necessary for ventricular fibrillation, and aggressive supportive care is important during the postresuscitation phase.
Recent advances in our understanding of the etiology, pathophysiology, and therapies tied to the timing, phase, and duration of cardiac arrest can improve outcomes for children. New epidemiological data and multicenter studies are ushering in the era of evidence-based pediatric resuscitation therapeutics.
总结小儿心肺复苏的当前观点和进展，包括病因、病理生理学、干预原理及复苏后管理。
儿童心脏骤停和心室颤动并不像先前报道的那样罕见。院外心脏骤停的发生率为每年每10万人中有8 - 20名儿童，而入住儿科重症监护病房的患儿中院内心脏骤停的发生率为2% - 6%。大多数小儿心脏骤停由窒息或循环性休克引发，但约10%由室性心动过速或心室颤动引发。此外，超过四分之一的院内心脏骤停患儿在事件过程中的某些时候会出现室性心动过速或心室颤动。院外心脏骤停后，约10%的患儿存活至出院，而院内心脏骤停后超过25%的患儿存活至出院。在心脏骤停的四个阶段（骤停前、无血流、低血流和复苏后），适当的干预措施有所不同：骤停前密切监测，无血流阶段及时进行心肺复苏可将该阶段时间减至最短，低血流阶段高质量的心肺复苏很重要，心室颤动时除颤必不可少，复苏后阶段积极的支持治疗很重要。
我们对与心脏骤停的时间、阶段和持续时间相关的病因、病理生理学及治疗方法的最新认识进展可改善儿童的预后。新的流行病学数据和多中心研究正在开启基于证据的小儿复苏治疗时代。
