107例心肺脑复苏应用高压氧综合治疗的经验  

Experiences with hyperbaric oxygen combined therapy for cardio-pulmonary-cerebral resuscitation in 107 cases

作　　者：吴嗣洪[1] 俞丽华[1] 金熊元[1] 

机构地区：[1]上海第二医科大学附属新华医院高压氧

出　　处：《中华航海医学杂志》1996年第3期138-142,共5页

摘　　要：目的：通过回顾性临床分析总结，探讨高压氧（ＨＢＯ）综合治疗在心肺脑复苏中的作用及经验。方法：心源性和各种意外事故引起的心脏骤停患者共１０７例，均经心肺复苏后开始以ＨＢＯ为主的综合治疗。其中心脏停跳≤４分钟４９例，＞４分钟５８例。ＨＢＯ治疗期间，部分病例在治疗前后作了心泵功能和脑电图检测。结果：ＨＢＯ治疗后３６例意识恢复（３３．６％），其中心脏停跳＞４分钟５８例中１３例意识恢复（２２．４％）。本组意识恢复时间为８０分钟～２５天，其中８０％于心肺脑复苏（ＣＰＣＲ）后５天内清醒，并可见ＨＢＯ治疗愈早，意识恢复率愈高，提示在脑水肿高峰前即开始ＨＢＯ治疗对复苏有利。本组存活３９例（３６．４％），心肺脑完全复苏２７例，意识恢复但遗留有神经系统后遗症７例，另有５例呈去皮质生存，总计有后遗症１２例（１１．２％）。同时发现ＨＢＯ治疗能明显改善缺氧后心泵的功能，有利于复苏后心功能的恢复。另通过对脑电图的观察，还证明复苏患者脑电图的表现对脑功能预后的判断有一定参考价值。结论：本组资料充分显示以ＨＢＯ为主的综合治疗对ＣＰＣＲ有积极作用，尤以对较长时间心脏停跳患者，能加速意识清醒、减少后遗症、提高复苏存活率。作者根据本组经验对如何合?Aim:Retrospective clinical analytic study was carried out in order to probe the effective mechanism of combined hyperbaric oxygen(HBO)therapy for cardio-pulmonary-cerebral-resuscitation (CPCR)with an attempt to present some experiences. Methods:The disease histories of sudden cardiac arrest due to cardiogenic or other accidental causes that were treated with HBO combined therapy were analysed, and among them the durations of cardiac arrest were≤4min in 49 cases and > 4 min in 58 cas-es. During the HBO treatment period, a part of the patients were given heart pump function test and EEG examination before and after the HBO therapy. ResuIts:Thirty-six patients(33.6%)regained con- sciousness after the HBO therapy, and thirteen of them(22.4%)had cardiac arrest for more than 4 min. The duration of regaining consciousness was from 80 min to 25 days, and 80%of the patients regained consciousness within 5 davs after the CPCR. It was also shown that the earlier the patient treated with HBO, the more the patients regained consciousness, which implied that it would be beneficial for the re-suscitation of patient to begin HBO therapy before the appearance of severe cerebral edema. Thirty-nine cases(36.4%)survived in this series, and 27 of them recovered completely,7 cases regained consious-ness but with neuroIogical sequelae and 5 cases were in vegetative state. So a total of 12 patients(11.2%)had neurolgical seq uelae. At the same time, HBO therapy was shown to improve the pump function of the heart dramatically and stabilize heart function after the resuscitation, Besides, the EEG of the sur-vived patients can give us a useful prognostic information of their cerebral function in the future. Conclu-sion:HBO combined therapy is very helpful in CPCR management especially for those patients with car-diac arrest of prolonged time. It can hasten the regainment of consciousness,lessen the neurological se-quelae, and increase the survival rate,Based on these experiences,the authors discussed the rational use of HBO therapy,in

关 键 词：复苏 心肺脑复苏 高压氧治疗 综合疗法 

分 类 号：R605.974[医药卫生—急诊医学] R459.6[医药卫生—外科学]