。1)復(fù)蘇成功。
(2)經(jīng)約30min BLS和ALS-CPR的搶救,心肌活動(dòng)毫無反應(yīng)?煽紤]停止復(fù)蘇術(shù)。
。3)我國現(xiàn)在尚未制訂“腦死亡”條例,國外,如法國,已有法律規(guī)定,做兩次腦電圖,均無腦活動(dòng)表現(xiàn),并經(jīng)兩位主治醫(yī)師鑒定,明確為腦死亡,復(fù)蘇術(shù)可以中止。
心臟驟停后復(fù)蘇的成敗關(guān)鍵在于是否盡早開始BLS和ALS的CPR措施。因此必須在現(xiàn)場就開始CPR術(shù),并在將病人安全地轉(zhuǎn)運(yùn)途中繼續(xù)治療,至接收醫(yī)院急診室(早就組建了急救網(wǎng))進(jìn)一步搶救。除了胸外按壓和人工呼吸,早行氣管插管聯(lián)接呼吸機(jī)和電擊除顫已越來越顯示其重要性。然后建立靜脈通道、監(jiān)測病人循環(huán)、呼吸功能以及其他生理指標(biāo)。根據(jù)所得參數(shù),給以相應(yīng)藥物。第一線藥物是腎上腺素、阿托品、溴芐胺和利多卡因。
腦復(fù)蘇是很關(guān)鍵的問題,目前雖然尚無肯定的恢復(fù)腦功能的藥物,但對腦組織缺氧性缺血時(shí)的病理生理變化的研究正逐步深入,解決腦復(fù)蘇的辦法已不會(huì)是很遠(yuǎn)。
心臟驟停的復(fù)蘇過程間接反映了急診醫(yī)療體系三個(gè)組成部分的密切關(guān)系與協(xié)調(diào)組合:院前搶救、醫(yī)院急診室與ICU或CCU監(jiān)護(hù)強(qiáng)化病室。
(邵孝鉷)
參考文獻(xiàn)
[1] Nayler WG & Elz JS:Reperfusion injury:Laboratory artifact or clinical dilemma Circulation 1986;74:215~221
[2] Weisfedt ML & Halperin HR: Cardiopulmonary resuscitation:Beyond cardiac massage.Circulation 1986;74:443~449
[3] Kirsch JR, Dean JM & Rogers MC:Current concepts in brain resuscitation.Arch Intern Med 1986;146:1413~1419
[4] Eisenber MS,Cummins RO & Ho MT (eds):Cardiac Arrest and Resuscitation.Philadelphia,WB Saunders Company,1987
[5] Chow MSS,Kluger J,DiPersio DM,et al:Antifibrillatory effects of lidocaine and bretylium immediatly postcardiopulmonary resuscitation.Am Heart J 1985;110:938~943
[6] Babbs CF:Role of iron ions in the genesis of reperfusion injury following successful cardiopulmonary resuscitation:Preliminary data and a biochemical hyposis.Ann Emerg Med 1985;14:777~783
[7] Young GP:Calcium channel blockers in emergency medicine.Ann Emerg Med 1984;13:712~722
[8] Vanhoutte PM:The Expert Committee of the World Health Organization on classification of calcium antagonists:The viewpoint of the raporteur.Am J Cardio 1987;59:(suppl) 3A~8A
[9] Danzl DF: Advanced Airway Support,in Tintinalli JE,Rothstein & Krome RL(eds):Emergency Medicine-A Comprehensive Study Guide-American College of Emergency Physicians.New York,McGraw-Hill Book Company,1985
[10] National Conference on Cardiopulmonary Resuscitation(CPR)and Emergency Cardiac Care (ECC):Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardia care(ECC).JAMA 1986;255:2905~2969