亞低溫技術(shù)在心肺復蘇中的應(yīng)用陸一鳴-資料下載頁
2025-01-18 17:09本頁面
【正文】 顱壓）反彈和體溫過高 ? 增加寒戰(zhàn) ? 過度的護理操作（冰墊 /降溫毯）對病情不穩(wěn)定的患者有不良影響 血管腔內(nèi)降溫 ? 開始治療容易（中心靜脈入路） ? 不影響患者的護理工作 ? 與體表降溫相比減少寒戰(zhàn)次數(shù)容易 ? 快速與患者分離 ? 有效地控制降溫后的患者體溫反彈， ICU 患者最多可以使用 4天 血管內(nèi)降溫 冰毯 結(jié)果： 與表面降溫組相比，血管內(nèi)降溫組： ?降溫迅速 ?在溫度維持階段，溫度波動小 (177。 ℃ ) ?復溫更加迅速 European ICU survey: therapeutic hypothermia use (Boerriger et al, 2022) ? Around 60% reported use of therapeutic hypothermia ? 65% cooled all atose survivors – 10% only witnessed arrest – 10% only VF/VT ? Reasons given for not using TH: – lack of science (5%) and fear of sideeffects (2%) – lack of consensus (10%) – lack of equipment (25%) A ”COOL” SUCCESS STORY : rapid implementation of therapeutic hypothermia in Norway ? All patients with ROSC after cardiac arrest who are not following verbal mands! ? Only witnessed arrest ? Only VF/VT and age 1875 (HACA/Bernard study inclusion criteria) ? outofhospital – ventricular fibrillation★★★ – Asystole★★ – pulseless electrical activity（ PEA） ★★ Patient selection ? When should mild hypothermia be started? ? How rapidly should the cooling take place? ? How long to cool ? 12 hours or 24 hours (NEJM 2022。 346:549–556 vs. 346:557–563) ? ? Target temperature? 33 degrees or 35 degrees Celsius? ? How rapidly should warming take place? ? Is therapeutic hypothermia efficacious for patients with initial rhythms other than ventricular fibrillation? ? Can we differentiate those patients who will benefit from mild hypothermia and those who will not? Still a lot of questions… Prognostic indicators ? In a metaanalysis of 11 studies involving almost 2022 patients in cardiac arrest, there were no immediate clinical signs to predict neurologic oute. ? The best clinical signs : absent corneal reflexes at 24 h。 absent pupillary response at 24 h。 no motor response at 24 h。 and no motor response at 72 h. ? The estimate of poor oute for atose patients following arrest was 77% which increased to 97% with negative clinical indicators at 24–72 h. ? An electroencephalogram after 24–48 h of care may also be a useful prognostic guide.
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