摘要
心搏骤停（CA）是最严重的临床急症,高质量的心肺脑复苏（CPCR）是最为有效的抢救方法.常规心肺复苏（CPR）30 min无效后,延长复苏时间可挽救更多患者的生命.如何提高超长CPR患者出院存活率和生存质量是目前研究的热点.新疆石河子市人民医院急救中心收治1例发生2次CA的患者.该患者于2002年因急性心肌梗死（AMI）突发阿-斯综合征,经35 min CPR成功后给予尿激酶静脉溶栓治疗,2 h临床判断再通,住院25 d痊愈出院.2016年患者再次发生CA,经185 min CPR成功后发生CA后综合征,经连续性血液净化（CBP）治疗,调节置换液温度至35℃,达到脑保护目标温度管理（TTM）要求,持续亚低温治疗7 d,患者住院75 d临床痊愈出院,随访9个月日常生活自理,可从事一般家务劳动.本文详细介绍该患者救治经过,为临床治疗提供借鉴.
Cardiac arrest （CA） is the most serious clinical emergency situation and cardiopulmonary-cerebral resuscitation （CPCR） performed on site with high quality is the optional therapy for its management. It has been reported that prolonging the resuscitation time after 30-minute failed conventional cardiopulmonary resuscitation （CPR） could improve the in-hospital survival rate of CA patients, and how to improve the out-hospital survival rate and survival quality of these patients is a research hot focus at present. A male patient admitted to Emergency Center of Shihezi People＇s Hospital reported in Xinjiang in this study had two CAs. In 2002, he experienced Adams-Strokes syndrome due to acute myocardial infarction （AMI） and survived after 35-minute of successful CPR. The criminal vessel was judged to re-canalize clinically 2 hours after thrombolytic therapy with urokinase, and he was cured and discharged from hospital 25 days later. In 2016, the second CA insult him and after the 185-minute CPR, he survived but experienced the post-CA syndrome. As long as 7-day continuous mild hypothermia was performed, the temperature of displacement fluids in continuous blood purification （CBP） was adjusted to 35 ℃ to achieve the goal of brain protection management requirements. He was cured and discharged from hospital 75 days later. During the 9-month follow-up, he did well in activities of daily living and could engage in routine housework. This paper introduces the treatment process of the patient in detail, and provides experience for clinical treatment.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第11期1032-1034,共3页
Chinese Critical Care Medicine
基金
新疆维吾尔自治区石河子市卫生科研项目（2012YL03）
关键词
心搏骤停
超长心肺脑复苏
溶栓治疗
目标温度管理
连续性血液净化
Cardiac arrest
Prolonged cardiopulmonary and cerebral resuscitation
Thrombolytic therapy
Targeted temperature management
Continuous blood purification
