普胸外科手术中心脏骤停5例临床分析

目的 探讨普胸外科开胸手术中心脏骤停发生的原因及抢救措施等.方法 回顾性分析5例非外伤性普胸外科手术中心脏骤停患者的临床资料.结果 肺部手术发生2例,食管手术3例,抢救成功4例,1例患者因术后再次出现心脏骤停死亡.结论 平稳的麻醉、术中良好的监护,可预防和早发现心脏骤停的发生.有创动脉压监测在心电干扰时有助于及时发现心...     

提高心肺脑复苏抢救效果的体会

<正> 如何提高心肺脑复苏的效果是临床重要的课题,我科于1992年1月至1996年1月采用系列综合治疗措施,抢救心脏骤停18例,现将心肺脑复苏的体会介绍如下。     

心肺复苏操作考核结果分析

目的 通过训练考试,掌握有效的心肺复苏方法,提高心脏骤停患者的抢救成功率.方法 对全院117名护士进行心肺复苏操作训练及考试.结果 合格率为92.3%.在心脏骤停的判断、开放气道和人工呼吸及胸外心脏按压方面存在不少操作细节问题.结论 应认真对待心肺复苏操作训练,熟练掌握动作要领和细节,方能正确灵活运用于临床患者的抢救,提高抢救成功率.     

肾上腺素与甲氧胺抢救心脏骤停患者临床观察的比较

肾上腺素与甲氧胺抢救心脏骤停患者临床观察的比较宋德富作者单位：５１５０４１广东省，汕头大学医学院附属一院麻醉科我院１９８８年１月～１９９５年１０月收治心脏骤停２２例，随机应用肾上腺素复苏１０例，应用甲氧胺复苏１２例，报告如下。资料与方法２２例中男１６...     

心脏骤停后综合征患者的ICU脑复苏优化治疗

目的 探讨ICU优化治疗对心脏骤停后综合征患者脑复苏的治疗效果.方法 34例心肺复苏成功,恢复自主循环并维持超过24 h以上,年龄大于18岁的成年患者(门急诊收治26例,院内转科8例),采用优化综合治疗措施,包括低温、脱水、脑复苏等,并于2周后根据格拉斯哥-比兹堡法评估脑复苏效果.结果 34例患者脑功能完好者7例(20.6％),中度脑功能残障4例(11.8％),严重脑功能残障6例(17.6％),昏迷8例(23.5％),死亡9例(26.5％).良好神经学结局者11例(32.4％).良好神经学结局组和不良结局组患者比较,复苏开始时间、机体恢复自主循环后48 h的GCS评分、自主循环状态差异有统计学意义(P＜0.05).结论 ICU的优化治疗措施有利于心脏骤停后综合征患者的脑复苏,但脑复苏结局还取决于心跳骤停的原因、复苏开始时间以及早期复苏的质量.     

心肺复苏操作考核结果分析

目的通过训练考试，掌握有效的心肺复苏方法，提高心脏骤停患者的抢救成功率。方法对全院117名护士进行心肺复苏操作训练及考试。结果合格率为92．3％。在心脏骤停的判断、开放气道和人工呼吸及胸外心脏按压方面存在不少操作细节问题。结论应认真对待心肺复苏操作训练，熟练掌握动作要领和细节，方能正确灵活运用于临床患者的抢救，提高抢救成功率。     

心脏骤停救治中的共识与争议

2010年10月颁布的（2010美国心脏协会心肺复苏及心血管急救指南》（以下简称“2010指南”）是基于大量循证医学证据,由数百位国际复苏学和临床专家对数千份经过同行审核的论文进行评估、讨论和辩论后制定,现已成为临床医师抢救心脏骤停患者的指导性文献。但由于心脏骤停的突发性和相关伦理学问题,迄今我们对于心脏骤停和心、肺、脑复苏的许多环节仍一知半解。     

心脏骤停复苏后亚低温治疗的护理进展

亚低温(32～34℃)治疗能为多种原因导致的全身或局部神经损伤提供神经保护.对由室颤引起的院外心脏骤停复苏后的昏迷成年患者采用亚低温疗法已纳入国际复苏联络委员会的复苏指南.从实施对象、时间、方法及并发症的预防4个方面对心脏骤停复苏后亚低温治疗的护理研究进展作一综述,以期对我国的相关临床研究起到促进作用.     

新式剖宫产新生儿窒息术中复苏护理

目的:探讨新式副宫产手术后出现新生儿窒息的抢救措施及复苏后护理.方法:30例患儿根据Apgar评分窒息程度分为轻度窒息共26例,重度窒息共4例,接复苏方案对窒息的新生儿进行急救复苏及护理.结果:重度窒息4例在手术室行复苏术后转儿科治疗,轻度窒息26例复苏后直接送产科病房,两组新生儿在护理前后Apgar评分差异均有统计学意义.结论:新生儿窒息抢救成功取决于及时正确的复苏技术及复苏后的护理,快速有效的抢救和严格认真的护理及医护密切配合,是提高抢救剖宫产手术窒息新生儿成功率、降低死亡率的有力保证.     

Willingness towards cardiopulmonary resuscitation training and implementation in community residents and its influencing factors

目的 了解社区居民学习和实施心肺复苏技能意愿的现状,并分析其原因.方法 采用自设问卷对郑州市2个社区的338名居民进行调查.问卷内容包括居民学习和实施心肺复苏的意愿、学习和实施心肺复苏技能的影响因素.结果 94.4％社区居民非常愿意或愿意参加心肺复苏培训,但仅有12.4％居民接受过相关培训.79.0％居民表示当目击亲人或朋友心脏骤停事件发生时,愿意对其实施心肺复苏；而陌生人发生心脏骤停时,仅29.9％愿意实施心肺复苏.影响居民学习心肺复苏技能的主要原因是未找到免费的专业培训机构.结论 社区居民学习心肺复苏技能的意愿很高,但普及率以及实施率较低.应大力宣传心肺复苏的重要性和实用性,经常到社区以及用人单位进行心肺复苏相关知识的培训.     

Late cardiac reoperation after cardiac transplantation

BACKGROUND: The intermediate and long-term results of cardiac transplantation continue to improve. Subsequent cardiac procedures may be required to extend patient survival and protect graft function. METHODS: The medical records of all adult and pediatric cardiac transplant recipients who underwent a subsequent cardiac procedure at our institution were reviewed. RESULTS: Three hundred sixty patients have undergone primary orthotopic transplantation in our institution. Seventeen patients (12 adults, 5 children) underwent a subsequent procedure requiring cardiopulmonary bypass including cardiac retransplantation (10), coronary artery bypass grafting (3), ascending aortic replacement (2), tricuspid valve repair (1), and myotomy and myomectomy (1 patient). Mean interval from time of transplantation to second procedure was 8.3 years. There was one perioperative death. Two patients, both retransplants, died late postoperatively at 22 and 84 months, respectively. Overall mean follow-up in the late survivors is 26.6 months. All survivors are currently asymptomatic and doing well. CONCLUSIONS: A variety of subsequent cardiac procedures, in addition to retransplantation, can be performed safely in carefully selected cardiac transplant recipients. The intermediate term results are gratifying in terms of survival and freedom from symptoms.     

Tissue-engineered cardiac constructs for cardiac repair

Several recent basic research studies have described surgical methods for cardiac repair using tissue cardiomyoplasty. This review summarizes recent advances in cardiac repair using bioengineered tissue from the viewpoint of the cardiac surgeon. We conclude that the results of many basic and preclinical studies indicate that bioengineered tissue can be adapted to conventional surgical techniques. However, no clinical studies have yet proved bioengineered tissue is effective as a treatment for human heart failure. Today's cardiac surgeons can look forward to the advent of new techniques to benefit patients who respond poorly to existing treatment for heart failure.     

胎羊心脏转流对胎羊心功能的影响

目的探讨胎羊心脏转流对不停跳下胎羊心功能的影响。方法孕120-140d母羊8只，共孕9只胎羊，随机分为对照组（n=4）和胎羊体外循环组（CPB组，n=5）。对照组胎羊开胸，不建立体外循环。CPB组建立胎羊心脏转流模型，转流30min。分别于转流前、转流30min、转流结束后1h、2h测胎羊平均动脉压、心率和动脉血气值。观察血肌钙蛋白（TnI）含量的变化，B超检测左、右心室Tei指数和脐动脉搏动指数（PI），观察心肌超微结构变化。结果两组胎羊平均动脉压、心率无显著变化。CPB组胎羊脱离体外循环后出现高碳酸血症和酸中毒，血氧分压无显著变化。对照组胎羊血气值无明显变化。CPB组胎羊左右心室Tei指数、脐动脉PI、血TnI含量均显著大于对照组（P〈0．05）。CPB组胎羊心肌细胞糖原明显减少。结论胎羊心脏转流对胎羊心功能造成损害，心功能不良与胎盘功能不良存在相互影响。     

Successful cardiac resynchronization therapy after cardiac surgery

Cardiac resynchronization therapy improves symptoms and survival in chronic heart failure patients, but has been poorly studied in the acute heart failure setting. We report the case of successful cardiac resynchronization therapy in the early postoperative period after cardiac surgery in a patient with left bundle branch block and proven ventricular dyssynchrony.     

Non-invasive measurements of cardiac output after cardiac surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -     

Hypophosphataemia causing profound cardiac failure after cardiac surgery

We report the case of a patient who developed severe cardiac failure after cardiac surgery and required high-dose inotrope infusion. The patient was found to have significant hypophosphataemia and high insulin requirements immediately after surgery. On giving intravenous phosphate, there was a rapid decrease in inotrope requirement and improved glycaemic control. This occurrence raises questions about the cause of hypophosphataemia after cardiac surgery, the possible need for pre-operative plasma phosphate measurement and whether phosphate replacement should be part of the standard management of postoperative hypophosphataemia.