2025年美国心脏协会心肺复苏和心血管急救指南摘要(中、英文版)

2025年美国心脏协会心肺复苏和心血管急救指南摘要(中、英文版)中文版2025年美国心脏协会（AHA）心肺复苏（CPR）和心血管急救指南对心肺复苏和心血管急救的多个方面进行了更新和细化，旨在进一步提高心脏骤停患者的生存率和预后质量。基础生命支持（BLS）1.成人CPR按压频率仍建议为100120次/分钟，按压深度至少5厘米但不超过6厘米。强调尽量减少按压中断，中断时间应控制在10秒以内。对于单人施救者，在进行30次胸外按压后，给予2次人工呼吸。双人施救时，按压与呼吸比为30:2。2.儿童和婴儿CPR儿童（1岁青春期）按压频率同样为100120次/分钟，按压深度至少为胸廓前后径的三分之一，约5厘米。婴儿（小于1岁）按压频率100120次/分钟，按压深度至少为胸廓前后径的三分之一，约4厘米。单人施救时按压呼吸比为30:2，双人施救时对于婴儿按压呼吸比可采用15:2。3.自动体外除颤器（AED）使用一旦获得AED，应立即使用。对于成人和8岁及以上儿童，使用成人电极片；对于小于8岁的儿童，建议使用儿童电极片。如果没有儿童电极片，成人电极片也可使用。高级心血管生命支持（ACLS）1.药物治疗肾上腺素仍是心脏骤停时的一线血管活性药物，建议在心脏骤停后尽快给予1mg静脉注射，每35分钟重复一次。胺碘酮可用于治疗室颤/无脉性室速对除颤、CPR和肾上腺素治疗无反应的情况，首次剂量为300mg静脉注射。2.气道管理在ACLS中，高级气道管理应根据患者情况和施救者技能进行选择。如果有经验的施救者在场，可考虑早期插入高级气道，如气管插管。但不建议为了插入高级气道而过度中断CPR。3.复苏后治疗复苏后患者应立即进行体温管理，目标体温控制在3236°C，持续24小时。同时，应进行全面的神经系统评估，以指导后续治疗和预后判断。特殊情况的CPR1.妊娠患者CPR妊娠晚期患者发生心脏骤停时，应将患者向左侧倾斜30°，以减轻子宫对下腔静脉的压迫。除颤操作与非妊娠患者相同，药物使用也遵循常规ACLS指南，但应考虑药物对胎儿的潜在影响。2.溺水患者CPR对于溺水患者，应立即将其从水中移出，进行CPR。如果患者有自主呼吸和脉搏，但处于昏迷状态，应将其侧卧，保持呼吸道通畅，并密切观察病情变化。公众教育和培训强调提高公众对CPR和AED使用的认知和技能。建议在社区、学校和工作场所广泛开展CPR和AED使用培训，以增加现场施救的可能性。英文版The2025AmericanHeartAssociation(AHA)GuidelinesforCardiopulmonaryResuscitation(CPR)andEmergencyCardiovascularCarehaveupdatedandrefinedmultipleaspectsofCPRandcardiovascularemergencycare,aimingtofurtherimprovethesurvivalrateandprognosisqualityofpatientswithcardiacarrest.BasicLifeSupport(BLS)1.AdultCPRThecompressionrateisstillrecommendedtobe100120compressionsperminute,andthecompressiondepthshouldbeatleast5cmbutnotmorethan6cm.Itisemphasizedtominimizecompressioninterruptions,andtheinterruptiontimeshouldbecontrolledwithin10seconds.Forsinglerescuers,after30chestcompressions,2rescuebreathsshouldbegiven.Whentworescuersarepresent,thecompressiontoventilationratiois30:2.2.PediatricandInfantCPRForchildren(1yearadolescence),thecompressionrateisalso100120compressionsperminute,andthecompressiondepthshouldbeatleastonethirdoftheanteriorposteriordiameterofthechest,approximately5cm.Forinfants(lessthan1year),thecompressionrateis100120compressionsperminute,andthecompressiondepthshouldbeatleastonethirdoftheanteriorposteriordiameterofthechest,approximately4cm.Thecompressiontoventilationratioforsinglerescuersis30:2.FortworescuerCPRininfants,acompressiontoventilationratioof15:2canbeused.3.AutomatedExternalDefibrillator(AED)UseOnceanAEDisavailable,itshouldbeusedimmediately.Foradultsandchildren8yearsandolder,adultpadsshouldbeused.Forchildrenyoungerthan8years,pediatricpadsarerecommended.Ifpediatricpadsarenotavailable,adultpadscanalsobeused.AdvancedCardiovascularLifeSupport(ACLS)1.PharmacologicalTherapyEpinephrineremainsthefirstlinevasoactivedrugincardiacarrest.Itisrecommendedtoadminister1mgintravenouslyassoonaspossibleaftercardiacarrest,andrepeatevery35minutes.Amiodaronecanbeusedforventricularfibrillation/pulselessventriculartachycardiathatisunresponsivetodefibrillation,CPR,andepinephrine.Theinitialdoseis300mgintravenousinjection.2.AirwayManagementInACLS,advancedairwaymanagementshouldbeselectedbasedonthepatient'sconditionandtherescuer'sskills.Ifanexperiencedrescuerispresent,earlyinsertionofanadvancedairway,suchasendotrachealintubation,canbeconsidered.However,excessiveinterruptionofCPRfortheinsertionofanadvancedairwayisnotrecommended.3.PostResuscitationCarePatientsafterresuscitationshouldimmediatelyundergotemperaturemanagement,withthetargettemperaturecontrolledat3236°Cfor24hours.Atthesametime,acomprehensiveneurologicalassessmentshouldbecarriedouttoguidesubsequenttreatmentandprognosisjudgment.CPRinSpecialSituations1.CPRinPregnantPatientsWhenapregnantpatientinthelatetrimestersufferscardiacarrest,thepatientshouldbetilted30°tothelefttorelievethecompressionoftheinferiorvenacavabytheuterus.Defibrillationisthesameasinnonpregnantpatients,anddrugusealsofollowstheconventionalACLSguidelines,butthepotentialeffectsofdrugsonthefetusshouldbeconsidered.2.CPRinDrowningPatientsFordrowningpatients,theyshouldbeimmediatelyremovedfromthewaterandCPRshouldbeinitiated.Ifthepatienthasspontaneousbreathingandapulsebutisinacoma,thepatientshouldbeplacedintherecoverypositiontokeeptheairwayclear,andtheconditionshouldbecloselymonitored.PublicEducationand