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心脏骤停后患者的重症监护

Critical Care of the Post-Cardiac Arrest Patient.

作者信息

Walker Amy C, Johnson Nicholas J

机构信息

Department of Emergency Medicine, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359702, Seattle, WA 98104, USA.

Department of Emergency Medicine, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359702, Seattle, WA 98104, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359702, Seattle, WA 98104, USA.

出版信息

Cardiol Clin. 2018 Aug;36(3):419-428. doi: 10.1016/j.ccl.2018.03.009.

Abstract

The post-cardiac arrest syndrome is a highly inflammatory state characterized by organ dysfunction, systemic ischemia and reperfusion injury, and persistent precipitating pathology. Early critical care should focus on identifying and treating arrest etiology and minimizing further injury to the brain and other organs by optimizing perfusion, oxygenation, ventilation, and temperature. Patients should be treated with targeted temperature management, although the exact temperature goal is not clear. No earlier than 72 hours after rewarming, prognostication using a multimodal approach should inform discussions with families regarding likely neurologic outcome.

摘要

心脏骤停后综合征是一种高度炎症状态,其特征为器官功能障碍、全身缺血和再灌注损伤以及持续的促发病理状况。早期重症监护应着重于识别和治疗心脏骤停的病因,并通过优化灌注、氧合、通气和体温来尽量减少对脑和其他器官的进一步损伤。尽管确切的体温目标尚不清楚,但应对患者进行目标温度管理。复温后不早于72小时,应采用多模式方法进行预后评估,以便与家属讨论可能的神经学转归。

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