91例心肺脑复苏成败原因分析  

A clinic analysis on91cases of cardiopulmonary cerebral resuscitation

作　　者：楼正家[1] 郑文龙[1] 诸葛丽敏[1] 欧阳侃[1] 

机构地区：[1]杭州市中医院,310007

出　　处：《浙江临床医学》2003年第7期491-492,共2页Zhejiang Clinical Medical Journal

摘　　要：目的 回顾分析心肺脑复苏 (CPCR)成功与失败的原因。方法 选择近10年来资料较齐全的CPCR病人91例 ,根据最终复苏情况分为3组 ,Ⅰ组为心搏、呼吸未恢复 ,Ⅱ组为心搏、呼吸已恢复 ,但脑复苏失败 ,Ⅲ组为智能部分或全部恢复。先列出年龄、性别、心脏骤停原因、发病至开始复苏时间、肾上腺素剂量、是否盲目除颤及有否亚低温等与CPCR相关的因素。根据所列因素统计出各组人数进行对比分析。结果 性别与复苏成败无关 (P>0.05) ;脑复苏成功率在21～30岁年龄段最高 (34.37%) ,其次为10～20岁 (25 %) ,随着年龄增大成功率下降。心源性者较非心源性者脑复苏成功率明显降低 (P<0.05)。发病至开始复苏时间5分钟内最好 ,心肺100%复苏 ,脑58.33 %复苏。大剂量肾上腺素可提高心肺复苏成功率 ,但是对脑复苏的成功率无明显影响。在院内盲目电击除颤未能提高复苏成功率。亚低温者脑复苏成功率72.22%,非亚低温成功率27.78 %(P<0.01)。结论 脑复苏的成功与以下因素直接相关 :(1)年龄40岁以下 ;(2)非心源性心脏骤停 ;(3)发病后10分钟内开始复苏 ;(4)在院内根据心电图表现决定是否电除颤 ;(5)肾上腺素宜先用小剂量 ,无效再用大剂量 ;(6)尽早给予亚低温。Objective To analyse retrospectively the reason of success and failure in91case cardiopulmonary cerebral resuscitation(CPCR). Methods Clinical data of91CPCR cases(from1991to2001)were collected and reviewed and were divided into3group on base of last resuscitation condition:those cardiopulmonary resuscitation failed were made as I group;those cardiopulmonary resuscitation succeeded but cerebral resuscitation failed were made as II group;those cardiopulmonary resuscitation succeeded and cerebral resuscitation partly or complete succeeded were made as III group.All relevant data were collected and analysed such as age,sex,reason of cardiac arrest(CA),dosage of adrenine,defibrillation or not,has or has not subˉhypothermia and so on. Results Sex has nothing to do with resuscitation success or failure(P>0.05).The ratio of success in cerebral resuscitation was highest in age21-30(34.37%),next was age10-20(25%),then the success ratio reduced along with age increasing.The ratio of cerebral resuscitation success in cardiogenic shock was sighificant higher than those of noncardiogenic shock(P<0.05).The highest success of resuscitation time was in5minute:cardiopulmonary resuscitation succeed ratio was100%,cerebral resuscitation succeed ratio was58.33%.Large dosage adrenine could increase success ratio of cardiopulmonary resuscitation,but had nothing to do with success ratio of cerebral resuscitation.Early defibrillation in hospital could not increase success ratio of resuscitation.The success ratio of cerebral resuscitation with subhypothermia was72.22%,but the success ratio of cerebral reˉsuscitation without subhypothermia was27.78%(P<0.01). Conclusion The results suggested that the success ratio of cerebral resuscitation was posˉitive correlated with(1)age under40,(2)no heart disease history,(3)got first aid within10min after CA,(4)accurate defibrillation,(5)small dosage adrenine in the beginning,but not large dosage of adrenine and(6)therapeutic subhypothermiaearly.

关 键 词：心肺脑复苏 原因 心脏骤停 亚低温 肾上腺素 电击除颤 

分 类 号：R459.7[医药卫生—急诊医学]