长时间复苏中缺血再灌注损伤的防护：一例病例报告及文献综述
Protection against ischemia-reperfusion injury in prolonged resuscitation: A case report and review of literature.
作者信息
Mohseni Masood, Ziaeifard Mohsen, Abbasi Zahra
机构信息
Assistant Professor, Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Resident, Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
出版信息
ARYA Atheroscler. 2014 Jul;10(4):227-9.
BACKGROUND
The severity of ischemia/reperfusion injury determines the neurologic outcome after successful cardiopulmonary resuscitation.
CASE REPORT
We present a case of prolonged open-chest resuscitation who survived without neurologic sequel. Multiple applied strategies to limit the deleterious effects of ischemia and reperfusion injury, that is, infusion of magnesium sulfate and mannitol, protective lung ventilation and optimal postoperative pain control prevented the end organ damage in this patient. During the 40 min open-chest resuscitation, ventricular defibrillation was successfully attempted with extrathoracic paddles.
CONCLUSION
The appropriate use of pharmacologic and non-pharmacologic protective strategies could modify the inflammatory cascade and minimize the deleterious effects of reperfusion after prolonged periods of ischemia. The successful defibrillation in this patient warrants the use of standard paddles in open-chest surgeries where surgical small paddles are not available.
背景
缺血/再灌注损伤的严重程度决定了心肺复苏成功后的神经学转归。
病例报告
我们报告一例长时间开胸复苏患者，该患者存活且无神经学后遗症。多种用于限制缺血和再灌注损伤有害影响的策略，即输注硫酸镁和甘露醇、保护性肺通气及优化术后疼痛控制，防止了该患者的终末器官损伤。在40分钟的开胸复苏过程中，成功尝试使用体外除颤板进行心室除颤。
结论
合理使用药物和非药物保护策略可改变炎症级联反应，并将长时间缺血后再灌注的有害影响降至最低。该患者成功除颤证明，在没有手术用小型除颤板的开胸手术中可使用标准除颤板。
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