原发性心脏骤停的原因致命性心律失常课件

心肺复苏与致命性心 律失常的急诊处理 郑大一附院心内科 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心肺复苏术最早的雏形源自16世纪一 个助产士采用口对口人工呼吸的方法 挽救了窒息心生儿的生命； 上世纪50至60年代先后报道了电除颤 技术、口对口呼吸人工通气术、胸外 心脏按压人工循环术、由此构成了现 代心肺复苏术的三大要素。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心肺复苏适应证 呼吸骤停 心脏骤停 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 原发性呼吸骤停后数分钟内心脏及大脑 仍能得到已氧合的血液供应，尚不会出 现循环停止的征象，此时紧急人工通气 非常重要，否则随之发生心脏停博。 原发性心脏骤停时血液循环立即中断 ，各重要脏器失去氧供，在心脏骤停 早期先出现数次无效的“叹息样”呼吸 动作，随之呼吸停之。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 原发性呼吸骤停原因 院外常见为意外事故，如溺水、外伤 窒息、气道异物阻塞、吸入刺激性烟 雾或过敏致急性喉头水肿、电击伤等 ； 院内常见原因为新生儿窒息、麻醉意 外、各种病因所致昏迷、外周及中枢 性呼吸衰竭、大面积肺栓塞、各系统 重症疾病的终末期。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 原发性心脏骤停的原因 致命性心律失常：以冠心病严重心 肌缺血或心肌梗死所导致的室颤或 无脉搏性室速最为常见，其次为心 肌病、长QT间期综合征、Brugada 综合征，以及严重心动过缓； 非心律失常原因：心脏破裂、心脏 流入或流出道急性梗阻，急性大量 心包积液致心脏压塞等。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心脏骤停的心电图表现主要 有以下三大类： 室颤（VF）/无脉搏室速（VT ） 心室停搏 无脉搏性电活动（pulseless electrical activity, PEA) Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 室扑 室颤 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 无脉搏性VT Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心室停搏：也称心室静止，心电图 上无QRS波，呈一条直线，或仅有 缓慢而不规则的心房波，但室上性 激动不能到达心室； PEA：也称电-机械分离，无有效的 心脏收缩，心电图上表现为缓慢而 不规则的心室自主节律或室性逸搏 律。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 冠心病心脏骤停患者多表现 为VF/VT； 心脏破裂、心脏压塞、流入/ 流出道梗阻、呼吸衰竭、肺 栓塞、终末期疾病患者多表 现为PEA或心室停搏。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 判断心脏骤停的主要指标 突发意识丧失 心音及大动脉搏动消失 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 识别心脏骤停 感觉呼吸 触诊颈动脉搏动 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 各脏器对缺血缺氧的耐受力 脑:大脑46分；小脑1015分； 延髓2030分；交感神经节60分 。 心脏、肾小管:30分。 肝细胞:12小时。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心脏骤停抢救成功的关键是尽早实 施心肺复苏（cardiopulmonary resuscitation, CPR） 心脏骤停虽然抢救成功，但最终又 发生死亡的最常见原因是中枢神经 系统损伤。 目前强调在整体意义上的心肺脑复 苏（ cardiopulmonary cerebral resuscitation, CPCR） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. CPCR程序： 基础生命支持（basic life support, BLS） 进一步生命支持（advanced life support, ALS） 长程生命支持（prolonged life support, PLS） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. BLS：ABC三部曲 A: airway开通气道 B: breathing人工呼吸 C: circulation胸外按 压 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. A 开通气道 仰头抬颏法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. B 人工呼吸 口对口人 工呼吸法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. C 胸外按压 部位、 方法、 频率 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 确定按压部位 使病人平卧于硬 板床或平地上； 以右手食、中指 沿肋弓向中线滑 动，找到肋骨与 胸骨连接处； Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 将左手掌贴在 患者胸骨的下 半部，右手掌 重叠放在这只 手背上，手掌 根部长轴与胸 骨长轴确保一 致； 仅以手掌根部 接触胸骨，掌 心和手指均应 抬起脱离胸壁 。 手掌放置方法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 按压用力方式 按压应平稳、有规律地进行，不能间断； 不能冲击式猛压，下压及向上放松的时间应大 致相等 肘关节伸直，垂直向下用力，不要左右摆动； 放松时定位的手掌根部不要离开胸骨定位点， 但应尽量放松，使胸骨不受任何压力； 按压频率：成人及小儿均为100次/分； 按压深度：成人45cm，513岁为3cm，婴幼 儿为2cm； 无论单人还是双人心肺复苏，均按30:2的按压- 通气比例进行。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 部位胸骨中下1/3处 频率 100次/分 幅度 4-5厘米 按压/通气比 30：2 心脏按压 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 胸外按压常见错误 按压时除掌根部贴在胸骨外，掌 心也压在胸壁上，容易引起肋骨 或肋软骨骨折； 按压定位不正确：向下错位易使 剑突受压折断而致肝破裂，向两 侧错位易致肋骨或肋软骨骨折， 导致气胸、血胸； 按压时肘部弯曲，因而用力不垂 直，按压力量减弱，按压深度达 不到45cm； Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 胸外按压常见错误 冲击式按压、猛压，其效果差，且易 导致骨折； 放松时抬手离开胸骨定位点，造成下 次按压部位错误，引起骨折； 放松时未能使胸部充分松弛，胸部仍 承受压力，使血液难以回到心脏； 按压速度不自主的加快或减慢，影响 按压效果。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. BLS时先通气？先按压？ （ABC or CAB） 如确定为冠心病所致VF、PEA 、心室停搏时，可首先按压， 然后通气； 如为溺水、窒息、呼衰、镇静 剂中毒等，一般先有严重缺氧 ，然后心室停搏，故应先通气 、随之按压。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 成人Heimlich法 解除气道异物的Heimlich法 儿童Heimlich法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 仅胸外 按压的 CPR （不愿 进行口 对口人 工呼吸 ） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2000心肺指南规定，如果给成人患 者复苏时不愿或不能行口对口呼吸 ，则应立即开始胸外按压，而不能 什么都不做。 研究表明，在CPR期间，胸廓随按 压起伏时的自动通气，可维持一定 的通气量。因为胸外按压时的心排 出量只有正常的25%，因而所需的 通气量也降低。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 进一步生命支持（ALS） 气管内插管机械通气 电除颤 建立静脉通道及复苏用药 ALS应尽可能早期开始，如人力足够，BLS与ALS 应同时分组进行。如病人未恢复自主循环与自 主呼吸，在采取ALS时，应持续进行CPR。如须 插管及除颤，CPR中断时间也应30s。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 电除颤 电极放置标准部位：胸骨右缘锁骨 下方、左第五肋间腋中线上； 电除颤仅适用于VF/无脉搏性VT， 均采用非同步模式，PEA/心室停 搏禁忌电击； 能量选择：200J、300J、360J； 一次除颤后立即CPR，而非连续多 次除颤 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 电除颤与电复律 电除颤只在CPCR时使用，非同步 模式，能量选择：200J、300J、 360J（单相波）：100J、150J、 150J（双相波）。 电复律使用同步模式，电流落在R 波下降支，用于房扑、房颤、单形 性室速的转复。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 电除颤心电图类型： 室扑 室颤 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 无脉搏室速 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 电复律心电图类型： 房扑 房颤 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 单形性（有脉搏）室速 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 关于“拳击除颤” 电触颤是心肺复苏的标准措施， 2000、2005心肺复苏指南中均未 提到“拳击除颤” 如已确定为室颤而电除颤暂时不 能实施时可尝试一次拳击并立即 开始CPR，禁忌连续多次拳击； 病人尚有意识、能触到脉搏的室 速、心室停搏、PEA等，均不能 拳击。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心肺复苏时应用的药物 肾上腺素 阿托品 血管加压素 胺碘酮 利多卡因 6. 多巴胺/多巴酚丁胺 7. 去甲/异丙肾上腺素 8. 碳酸氢钠 9. 葡萄糖酸钙 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 药物应用注意事项 有效胸外按压、人工通气、电除颤 是CPR的核心措施，只有在这些措 施实施的同时才考虑用药，而非先 用药然后才实施CPR。只静脉用药 ，不心内注射。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 肾上腺素 心脏骤停患者无论表现为何种心电图（ VF/无脉搏VT、心室停搏、PEA），肾上 腺素都是第一个经静脉应用的药物。 主要依赖其受体兴奋作用提升血压，增 加心、脑供血；受体作用可提高窦房结 兴奋性、使细颤变为粗颤，有利于心跳恢 复； 用法：标准剂量法：每次1mg，每35min 重复一次；大剂量法未被常规推荐，也可 应用递增剂量法（1、3、5mg） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 阿托品 阿托品只用于非VF所致的心脏 骤停患者，如心室停搏、PEA ； 用量：每次1mg，每35min重 复一次至总量3mg或0.04mg/kg 。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血管加压素 直接兴奋血管平滑肌V1受体收缩血管，半 衰期长（1020min）； 对皮肤、骨胳肌、小肠和脂肪血管收缩强 ，而对冠状动脉和肾血管床的收缩作用相 对较轻，对脑血管尚有扩张作用； 推荐用于VF所致心脏骤停者，经肾上腺 素、除颤后心跳仍未恢复者，尚不推荐用 于非VF所致的心脏骤停； 用法：40U静脉注射，仅用一次。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 胺碘酮/利多卡因 二者均用于VF/无脉搏VT所致心脏骤停患 者，在应用肾上腺素、血管加压素、除颤 之后仍为VF/VT者使用； 胺碘酮为一线药物，利多卡因位居第二， 只用于胺碘酮不能获得或胺碘酮无效时； 用法：胺碘酮300mg+20ml盐水快速iv，无 效时150mg重复iv，然后1mg/min静点6h， 0.5mg/min维持静点，24h总量2g以内；利 多卡因每次iv 1.5mg/kg，1020min重复一 次，1h内累积剂量不超过3mg/kg。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 多巴胺/多巴酚丁胺 二者均非CPR的一线用药； 在复苏成功、自主循环恢复后血压 仍低或心动过缓者使用； 二者可以合用，剂量范围均为 510g/kg/min； 如果为已建立静脉通路的院内患者 ，可以在进行CPR的同时使用。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 去甲/异丙肾上腺素 二者目前均已从CPR一线用药中退出 ； 去甲肾上腺素仅用于复苏成功后经上 述用药仍存在低血压者； 异丙肾上腺素仅用于非心脏骤停、非 血压降低的心动过缓者，以及尖端扭 转性室速患者。 二者用量均为0.52g/min Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 碳酸氢钠 心跳骤停时，足量的肺泡通气和组织血流 的恢复是控制酸碱平衡的基础 ； CPR永远是第一时间要采取的措施，只有 在胸外心脏按压、除颤、气管插管、机械 通气和血管收缩药治疗无效时方可考虑应 用该药 存在下列情况时，可在CPR开始之后即使 用碳酸氢钠：患者原有代谢性酸中毒、高 钾血症或三环类或苯巴比妥类药物 中毒。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. CPR时过早使用碳酸氢钠 的危害： 在动物实验中不能增强除颤效果或 提高存活率； 能降低血管灌注压； 可能产生细胞外碱中毒的副作用； 能导致高渗状态和高钠血症； 可加重中心静脉酸血症； 可使刚应用的儿茶酚胺失活。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 葡萄糖酸钙 CPR时不常规使用钙剂，只有存在 下列情况之一时才考虑使用： 高血钾 低血钙 钙通道阻滞剂中毒 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. BLSALS总结及简易流程 一旦确定心脏骤停：BLSA、B、C三部 曲；ALS 插管、除颤、用药； 所有心脏骤停病人，两种心律必居其一： VF/VT或非VF节律，后者包括PEA及心 室停搏； 没有必要将病人划分为VF、无脉搏VT、 PEA、心室停搏，因无脉搏VT的后果等 同于VF，而PEA与心室停搏的处理原则 相同。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 所有心脏骤停的患者都要得到同样4 种治疗： CPR 气管插管 血管收缩剂 抗心律失常药 唯一不同的治疗在于VF/VT须除颤。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心脏骤停VF/VT节律抢救流程 肾上腺素1mg 肾上腺素3mg 肾上腺素5mg 血管加压素40U 胺碘酮/利多卡因 电击200J 电击300J 电击360J 电击360J 电击360J CPR 多巴胺 多巴酚 丁胺 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 心脏骤停非VF节律抢救流程 肾上腺素1mg 阿托品1mg CPR 多巴胺 多巴酚 丁胺 肾上腺素3mg 阿托品1mg 肾上腺素5mg 阿托品1mg 考虑使用 碳酸氢钠 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 20