aDepartment of Emergency Medicine, Hennepin County Medical Center bDepartment of Medicine-Cardiovascular Division cDepartment of Integrated Biology and Physiology, University of Minnesota, Minneapolis, Minnesota, USA.
Curr Opin Crit Care. 2017 Jun;23(3):215-222. doi: 10.1097/MCC.0000000000000405.
Survival with favorable neurological function after cardiac arrest remains low. The purpose of this review is to identify recent advances that focus on neuroprotection during cardiopulmonary resuscitation (CPR).
Multiple strategies have been shown to enhance neuroprotection during CPR. Brain perfusion during CPR is increased with therapies such as active compression decompression CPR and intrathoracic pressure regulation that improve cardiac preload and decrease intracranial pressure. Head Up CPR has been shown to decrease intracranial pressure thereby increasing cerebral perfusion pressure and cerebral blood flow. Sodium nitroprusside enhanced CPR increases cerebral perfusion, facilitates heat exchange, and improves neurologic survival in swine after cardiac arrest. Postconditioning has been administered during CPR in laboratory settings. Poloxamer 188, a membrane stabilizer, and ischemic postconditioning have been shown to improve cardiac and neural function after cardiac arrest in animal models. Postconditioning with inhaled gases protects the myocardium, with more evidence mounting for the potential for neural protection.
Multiple promising neuroprotective therapies are being developed in animal models of cardiac arrest, and are in early stages of human trials. These therapies have the potential to be bundled together to improve rates of favorable neurological survival after cardiac arrest.
心脏骤停后能保持良好神经功能的存活率仍然较低。本文的目的是确定近期在心肺复苏（CPR）期间侧重于神经保护的研究进展。
多项策略已被证明可增强 CPR 期间的神经保护作用。通过主动按压-释放 CPR 和胸内压调节等治疗方法可增加脑灌注，这些方法可改善心脏前负荷和降低颅内压。头高位 CPR 可降低颅内压，从而增加脑灌注压和脑血流量。硝普钠增强的 CPR 可增加脑灌注，促进热量交换，并提高猪心脏骤停后的神经存活率。在实验室环境中，CPR 期间已实施了后处理。在动物模型中，泊洛沙姆 188（一种膜稳定剂）和缺血后处理已被证明可改善心脏和神经功能。吸入气体的后处理可保护心肌，越来越多的证据表明其具有神经保护的潜力。
目前正在心脏骤停动物模型中开发多种有前途的神经保护治疗方法，且处于人体试验的早期阶段。这些治疗方法有可能结合在一起，以提高心脏骤停后良好神经功能存活率的几率。
