摘要
每年数以万计的住院儿童发生心脏骤停,仅有一半左右的患儿能存活至出院。及时识别心脏骤停,尽早启动高质量的心肺复苏是改善预后的关键。在复苏过程中,心肺复苏持续时间越长,存活率越低。避免心脏节律恶化成心室颤动、无脉性室性心动过速等恶性心律,尽早使用肾上腺素对改善生存是有益的。对于可电击心律,建议除颤初始剂量为2J/kg。侵入性气道在复苏中可能是有害的。对于有条件的医疗机构,选择合适的病例尽早行体外心肺复苏有利于改善预后。复苏后应维持正常氧供和常压通气,采用动脉舒张压、呼气末二氧化碳等生理监测指导复苏后管理,而亚低温治疗并未在改善预后方面带来益处。脑电图、CT、磁共振成像等影像学检查可以早期评估复苏后的神经预后,神经元特异性烯醇化酶、S100钙结合蛋白及体感诱发电位等具有更好的预测价值,但缺少足够的临床研究。
Thousands of children experience cardiac arrest in hospital each year,and only about half of them can survive to hospital discharge.Recognizing cardiac arrest in time and initiating high-quality cardiopulmonary resuscitation as early as possible is the key to improve the prognosis.During resuscitation,the longer the duration of cardiopulmonary resuscitation,the lower the survival rate.To prevent the heart rhythm from deteriorating into ventricular fibrillation,pulseless ventricular tachycardia and other malignant rhythms,timely use of adrenaline is beneficial to improve survival.For shockable heart rhythms,the recommended initial dose of defibrillation is 2 J/kg.Invasive airways can be harmful during resuscitation.For qualified medical institutions,choosing appropriate cases to perform extracorporeal cardiopulmonary resuscitation as soon as possible will improve the prognosis.After resuscitation,normal oxygen supply and normal pressure ventilation should be maintained,and physiological monitoring such as arterial diastolic pressure and end-tidal carbon dioxide should be used to guide post-resuscitation management.However,mild hypothermia treatment does not bring benefits to improve the prognosis.Imaging tests such as EEG,CT,and magnetic resonance imaging can assess the prognosis of nerves after resuscitation early,while neuron-specific enolase,S100 calcium binding protein,and somatosensory evoked potential have better predictive value,but lacking of enough clinical data.
作者
李旭锋
郭予雄
Li Xufeng;Guo Yuxiong(Pediatric Intensive Care Unit,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)
出处
《中国小儿急救医学》
CAS
2021年第11期1005-1009,共5页
Chinese Pediatric Emergency Medicine
关键词
心脏骤停
预后
院内
心肺复苏
儿童
Cardiac arrest
Prognosis
In-hospital
Cardiopulmonary resuscitation
Children
