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Part 4: Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.第4部分:高级生命支持:2015年国际心肺复苏和心血管急救科学与治疗建议共识。
Circulation. 2015 Oct 20;132(16 Suppl 1):S84-145. doi: 10.1161/CIR.0000000000000273.
2
The association between hyperoxia and patient outcomes after cardiac arrest: analysis of a high-resolution database.心脏骤停后高氧与患者预后的关联:一项高分辨率数据库分析
Intensive Care Med. 2015 Jan;41(1):49-57. doi: 10.1007/s00134-014-3555-6. Epub 2014 Dec 4.
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The association between systolic blood pressure on arrival at hospital and outcome in adults surviving from out-of-hospital cardiac arrests of presumed cardiac aetiology.因推测心脏病因导致院外心脏骤停后存活的成人患者,入院时收缩压与预后之间的关联。
Resuscitation. 2014 Apr;85(4):509-15. doi: 10.1016/j.resuscitation.2013.12.005. Epub 2013 Dec 12.
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Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial.院前轻度低温诱导对心脏骤停成人存活率和神经状态的影响:一项随机临床试验。
JAMA. 2014 Jan 1;311(1):45-52. doi: 10.1001/jama.2013.282173.
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Targeted temperature management at 33°C versus 36°C after cardiac arrest.心脏骤停后 33°C 与 36°C 的目标温度管理。
N Engl J Med. 2013 Dec 5;369(23):2197-206. doi: 10.1056/NEJMoa1310519. Epub 2013 Nov 17.
6
Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest.体温过低后发热与院外心脏骤停后死亡率增加有关。
Resuscitation. 2013 Dec;84(12):1734-40. doi: 10.1016/j.resuscitation.2013.07.023. Epub 2013 Aug 2.
7
Association between postresuscitation partial pressure of arterial carbon dioxide and neurological outcome in patients with post-cardiac arrest syndrome.心肺复苏后患者动脉血二氧化碳分压与心搏骤停后综合征患者神经功能预后的关系。
Circulation. 2013 May 28;127(21):2107-13. doi: 10.1161/CIRCULATIONAHA.112.000168. Epub 2013 Apr 23.
8
Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.拯救脓毒症运动:严重脓毒症和脓毒性休克管理国际指南:2012 年。
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9
Early-onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis.心搏骤停后早发性肺炎:特征、危险因素及其对预后的影响。
Am J Respir Crit Care Med. 2011 Nov 1;184(9):1048-54. doi: 10.1164/rccm.201102-0331OC.
10
Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest.治疗性低温期间血糖变异性增加与心脏骤停后的结局。
Crit Care Med. 2011 Oct;39(10):2225-31. doi: 10.1097/CCM.0b013e31822572c9.

复苏后护理。

Post-resuscitation care.

作者信息

Pothiawala Sohil

机构信息

Department of Emergency Medicine, Singapore General Hospital, Singapore.

出版信息

Singapore Med J. 2017 Jul;58(7):404-407. doi: 10.11622/smedj.2017060.

DOI:10.11622/smedj.2017060
PMID:28741014
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5523091/
Abstract

Following return of spontaneous circulation (ROSC) after cardiac arrest, the challenge is to institute measures that ensure a higher likelihood of neurologically intact survival. Regardless of the cause of collapse, multiple organ systems may be affected secondary to post-cardiac arrest syndrome. Interventions required for post-ROSC care are bundled into a care regimen: prompt identification and treatment of the cause of cardiac arrest; and treatment of electrolyte abnormalities. It is also essential to establish definitive airway management to maintain normocapnic ventilation, prevent hyperoxia, and optimise haemodynamic management via judicious intravenous fluids and vasoactive drugs. Targeted temperature management after ROSC confers neuroprotection and leads to improved neurological outcomes. Glycaemic control of blood glucose levels at 6-10 mmol/L, adequate seizure management and measures to optimise neurological functions should be integrated into the care bundle. The interventions outlined can potentially lead to more patients being discharged from hospital alive with good neurological function.

摘要

心脏骤停后自主循环恢复(ROSC)后,面临的挑战是采取措施,以确保患者在神经功能完好的情况下存活的可能性更高。无论心脏骤停的原因是什么,心脏骤停后综合征可能会继发影响多个器官系统。ROSC后护理所需的干预措施被整合到一个护理方案中:迅速识别和治疗心脏骤停的原因;以及治疗电解质异常。建立确定性气道管理以维持正常碳酸血症通气、预防高氧血症,并通过合理使用静脉输液和血管活性药物优化血流动力学管理也至关重要。ROSC后进行目标温度管理可提供神经保护并改善神经功能结局。将血糖水平控制在6-10 mmol/L、充分控制癫痫发作以及优化神经功能的措施应纳入护理方案中。上述干预措施有可能使更多患者存活出院且神经功能良好。