心跳骤停后亚低温治疗

心肺复苏后亚低温治疗,河北医科大学第三医院急诊科秦延军2016-9-24,目录,1.心跳骤停流行病学,2.亚低温与指南,3. 最佳目标温度,4.亚低温并发症及处理,心跳骤停病死率高,心脏骤停的存活率低，据统计，院外存活率6%，院内18%，平均18 years),in cardiac arrest on EMS arrival, had IV access establishedwere still in cardiac arrest after initial resuscitation treatments.,排除标准in cardiac arrest as a result of trauma (including hanging), suspected intra-cranial bleeding, females who were known or suspected to be pregnant, already hypothermic (34.5C), or in-patients in a hospital.,Randomization and Intervention,随机 an opaque envelope containing computer-generated random treatment allocation,处理 a rapid infusion of 30mL/kg cold saline (maximum 2L) via a peripheral intravenous cannula, or continued standard care.,停止输液条件reached 33C or if pulmonary edema was suspected,Outcomes,The primary outcome measure was survival at hospital dischargeSecondary outcome measures were the proportion of patients in shockable and non-shockable rhythms with ROSC,快速输液使右房压增加，降低了冠脉灌注压，且可以导致肺水肿,心脏温度低使得对除颤反应性差，这一点有争议,低温持续的时间和复温,目标温度持续时间至少24h复温速度控制在0.25-0.5/h复温后温度应控制在37.5以下，至少维持到复苏后72h,DOI 10.1186/s13049-015-0121-3,并发症处理,寒颤：处理：镇静药、麻醉药，镁，肌松药，皮肤保暖高血糖：低温降低胰岛素敏感性及胰岛素的分泌，血糖增高，需要强化胰岛素治疗复温时注意低血糖发生低钾血症：低温导致细胞外钾离子转移至细胞内；导致肾小管功能障碍，分泌钾增多凝血功能障碍感染风险增加,低温对凝血的影响,尽管轻到中度低温对患者凝血系统有影响，与低温有关的出血风险非常低。对于伴有中到重度酸中毒的患者出血风险增加。如果温度控制35C，低温对患者无影响，即使患者具有较高出血风险在此温度都很安全,Kees H Polderman.Hypothermia and coagulation. Critical Care 2012, 16(Suppl 2):A20,Hypothermia and coagulation， Critical Care 2012,低温与感染,低温抑制细胞和体液免疫肺部感染常见，心肺复苏、急诊气管插管、机械通气有关，这些可以引起血行感染和导管感染。研究发现这些感染并没有增加病死率。,Mongardon N. Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era. Crit Care Med. 2011;39:13591364,Tsai MS. Infections in the survivors of out-of-hospi