2025年美国心脏协会心肺复苏和心血管急救指南摘要(中文、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(中文、英文版)中文版2025年美国心脏协会心肺复苏和心血管急救指南在基础生命支持（BLS）、高级心血管生命支持（ACLS）、复苏后护理等多个关键领域进行了更新和细化，旨在提高心脏骤停患者的生存几率和预后质量。基础生命支持对于非专业施救者，指南强调了快速识别心脏骤停和启动急救系统的重要性。鼓励在发现患者无反应且无正常呼吸时，立即拨打急救电话并开始心肺复苏（CPR）。在CPR操作方面，维持至少100次/分钟且不超过120次/分钟的胸外按压频率，按压深度为至少5厘米但不超过6厘米。对于未经培训的旁观者，单纯胸外按压CPR是一种有效的替代方法，可显著提高患者生存率。自动体外除颤器（AED）的使用进一步得到推广。指南建议在可能的情况下，尽快获取并使用AED。一旦AED到达，应立即按照语音提示进行操作，在进行电击除颤前确保无人接触患者。同时，对于目击的成人心脏骤停，应在进行2分钟CPR后尽快使用AED。高级心血管生命支持在ACLS中，急救团队的协调和沟通至关重要。团队成员应明确各自职责，确保高效的CPR实施和药物使用。对于心脏骤停患者，尽早给予肾上腺素仍然是关键的治疗措施。指南推荐在心脏骤停发生后尽快静脉注射1毫克肾上腺素，每35分钟重复一次。对于可除颤心律（室颤和无脉性室速），应尽快进行电击除颤。首次电击能量推荐使用双相波除颤器的120200焦耳，后续电击可使用相同或更高能量。除颤后应立即继续进行CPR，直至心律检查显示需要再次除颤或患者恢复自主循环。在气道管理方面，对于需要高级气道支持的患者，应优先考虑使用声门上气道装置（如喉罩），而不是传统的气管插管。声门上气道装置具有操作简单、成功率高的优点，可在不中断CPR的情况下快速建立气道。复苏后护理复苏后护理对于提高患者的神经功能预后至关重要。指南建议对复苏后患者进行目标温度管理（TTM），将体温控制在3236℃之间，持续24小时。TTM可减少脑损伤，提高患者的生存率和神经功能恢复率。同时，应密切监测患者的生命体征、血流动力学和神经功能状态。对于有指征的患者，应尽早进行冠状动脉造影和再灌注治疗，以改善心肌灌注和心脏功能。此外，心理支持和康复治疗也应纳入复苏后护理的范畴，帮助患者及其家属应对疾病带来的心理压力和生活变化。特殊情况的处理对于特殊人群和特殊情况的心脏骤停，指南也提供了针对性的建议。例如，对于孕妇心脏骤停，应采取左侧卧位以减轻子宫对下腔静脉的压迫，同时进行标准的CPR和除颤操作。对于溺水导致的心脏骤停，应在将患者从水中救出后立即开始CPR，无需进行长时间的控水操作。英文版The2025AmericanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEmergencyCardiovascularCarehavebeenupdatedandrefinedinseveralkeyareas,includingbasiclifesupport(BLS),advancedcardiovascularlifesupport(ACLS),andpostresuscitationcare,aimingtoimprovethesurvivalrateandprognosisqualityofcardiacarrestpatients.BasicLifeSupportForlayrescuers,theguidelinesemphasizetheimportanceofquicklyrecognizingcardiacarrestandactivatingtheemergencyresponsesystem.Itisencouragedthatwhenapatientisfoundunresponsiveandnotbreathingnormally,therescuershouldimmediatelycallforemergencyhelpandstartcardiopulmonaryresuscitation(CPR).IntermsofCPRoperation,maintainachestcompressionrateofatleast100andnomorethan120compressionsperminute,withacompressiondepthofatleast5cmbutnomorethan6cm.Foruntrainedbystanders,handsonlyCPRisaneffectivealternativemethodthatcansignificantlyimprovethepatient'ssurvivalrate.Theuseofautomatedexternaldefibrillators(AEDs)isfurtherpromoted.TheguidelinesrecommendobtainingandusinganAEDassoonaspossiblewhenavailable.OncetheAEDarrives,operateitimmediatelyaccordingtothevoiceprompts,andensurethatnooneistouchingthepatientbeforedeliveringashock.Meanwhile,forwitnessedadultcardiacarrests,theAEDshouldbeusedassoonaspossibleafter2minutesofCPR.AdvancedCardiovascularLifeSupportInACLS,thecoordinationandcommunicationoftheresuscitationteamarecrucial.TeammembersshouldclearlydefinetheirresponsibilitiestoensureefficientCPRimplementationanddrugadministration.Forpatientsincardiacarrest,earlyadministrationofepinephrineremainsakeytreatmentmeasure.Theguidelinesrecommendanintravenousinjectionof1mgofepinephrineassoonaspossibleaftercardiacarrest,repeatedevery35minutes.Forshockablerhythms(ventricularfibrillationandpulselessventriculartachycardia),defibrillationshouldbeperformedassoonaspossible.Therecommendedinitialshockenergyforbiphasicdefibrillatorsis120200joules,andsubsequentshockscanusethesameorhigherenergy.Afterdefibrillation,CPRshouldbeimmediatelyresumeduntilarhythmcheckindicatestheneedforanothershockorthepatientregainsspontaneouscirculation.Inairwaymanagement,forpatientsrequiringadvancedairwaysupport,supraglotticairwaydevices(suchaslaryngealmasks)shouldbeprioritizedovertraditionaltrachealintubation.Supraglotticairwaydeviceshavetheadvantagesofsimpleoperationandhighsuccessrate,andcanquicklyestablishanairwaywithoutinterruptingCPR.PostResuscitationCarePostresuscitationcareiscrucialforimprovingtheneurologicalprognosisofpatients.Theguidelinesrecommendtargetedtemperaturemanagement(TTM)forpostresuscitationpatients,maintainingthebodytemperaturebetween3236℃for24hours.TTMcanreducebraininjury,improvethepatient'ssurvivalrateandneurologicalrecoveryrate.Atthesametime,thepatient'svitalsigns,hemodynamics,andneurologicalstatusshouldbecloselymonitored.Forpatientswithindications,coronaryangiographyandreperfusiontherapyshouldbeperformedasearlyaspossibletoimprovemyocardialperfusionandcardiacfunction.Inaddition,psychologicalsupportandrehabilitationtreatmentshouldalsobeincludedinpostresuscitationcaretohelppatientsandtheirfamiliescopewiththepsychologicalstressandlifechangesbroughtaboutbythedisease.ManagementofSpecialSituationsTheguidelinesalsoprovidetargetedrecommendationsforcardiacarrestinspecialpopulationsandspecialsituations.Forexample,inthecaseofcardiacarrestinpregnantwomen,theleftlateralpositionshouldbeadoptedtorelievethecompressionoftheinferiorvena