心脏骤停并发症的预防和处理.ppt

心脏骤停并发症的预防和处理; 定 义;诊 断 要 点 ;CA的时间相关性;CPR越早成活率越高;心肺复苏现状;2010版CPR指南更新; 即便是恢复自主循环（return of spontaneous circulation，ROSC) 后，患者的生存率仍然较低。决定这些患者生存率和死亡率的重要因素就是由于机体长时间缺氧而引起的心脑功能紊乱，人们将其称为心脏骤停后综合症或者复苏后综合症，主要包括：缺氧性脑损伤、心肌顿抑、系统性缺血/再灌注损伤等 ;CA患者复苏后并发症的预防及处理原则;CA患者复苏后并发症的预防及处理 ;CA患者复苏后并发症的预防及处理 ;心脏骤停后的心肌损害;早期最佳血流动力学目标;循环支持 ;循环支持 ;低温疗法 （TH）;CA患者复苏后并发症的预防及处理 ;心脏骤停后的脑损害;ATP消耗;低温治疗作用机制;低温治疗作用机制的新观念;低 温 疗 法;低温治疗的分类;Bladder Temperature in the Normothermia and Hypothermia Groups. The T bars indicate the 75th percentile in the normothermia group and the 25th percentile in the hypothermia group. The target temperature in the hypothermia group was 32℃ to 34 ℃, and the duration of cooling was 24 hours. Only patients with recorded temperatures were included in the analysis.;After 6 months: 75 of the 136 (55%) in hypothermia group had better favorable neurologic outcome than normothermia group (39%).;After 6 months: Rate of death (41%) in the hypothermia is 14% lower than in the normothermia group (39%). ;欧洲多中心临床试验（ HACA trial);澳大利亚的研究;Preliminary evidence in patients with asystole/PEA…;欧洲HART Study - ICY 在心脏骤停的多中心试验 ;;Before- and after comparison in 665 out-of hospital cardiac arrest in the Stavanger area (population 300 000) 2001-2003;Before- and after comparison in 665 out-of hospital cardiac arrest in the Stavanger area (population 300 000) 2001-2003;An advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation(ILCOR – includes AHA)(Published in Resuscitation, June 2003 and Circulation, July 2003);体表降温－冰袋;体表降温－kcl床;Invasive or non-invasive cooling technique?;Bernard et al, Rescuscitation 2003;56:9-13; Virkkunen et al., Resuscitation 2004; 62:299-302; Rijnsburger Intensive Care Med 2004 30:Suppl 1 abstr 475; Polderman et al. Critical Care Med 2005; 33:2744-51.;HACA 试验 vs ALSIUS Icy? ;体表降温和血管腔内降温;血管内降温;Temperature Profile Using Icy? Catheter (Cooling time: 98 minutes）; ;Probably as quickly as possible; How rapidly shoul