2010年AHA 心肺复苏指南介绍.ppt

1、Guidelines Writing Group Chairs Michael R. Sayre, MD,贵阳医学院附院麻醉科 曾庆繁,2010年AHA 心肺复苏指南介绍,In 1960,Kouwenhoven 14 病人 心跳骤停 闭式胸部心脏按压 存活 closed chest cardiac massage,in 1962,单向直流电除颤 direct-current monophasic waveform defibrillation,In 1966,American Heart Association (AHA) first CPR Guidelines 1995 2000 2005

2、,1960-2010 Kouwenhoven,2010心肺复苏50周年,356 位专家 来自29 个国家 历时36个月讨论,2010 International Consensus Conference,Robert A. Berg University of Pennsylvania Professor of Anesthesiology and Critical Care Medicine, Division Chief, Pediatric Critical Care,心脏骤停的几种节律Cardiac arrest can be caused by 5 rhythms,室颤 VF 室速(

3、无脉)VT 无脉性电活动PEA 心博停止asystole. 无脉性心动过缓,Three-Phase Model of Resuscitation,0,2,4,6,8,10,12,14,16,18,20,Arrest Time (min),0,100%,Myocardial ATP,Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8,rapid defibrillation,good chest compressions,little we can do,室颤 无脉性室速 VF/Pulseless VT 及早按压 chest compressions (

4、CC) 及早除颤 early Defibrillation (DF),Early recognition cardiac arrest,及早识别心跳骤停,不检查脉搏 Not check for a pulse 降低脉搏检查的重要性 Minimize the importance of pulse checks,脉搏,2005 (Old): “Look, listen, and feel”,NO: “Look, Listen, Feel for Breathing”*,呼吸 2010 (New): 取消“看、听和感觉呼吸”程序*,外行急救lay rescuer,1.突然晕倒 suddenly c

5、ollapse 2.意识消失 Unresponsive 3.无呼吸或无正常呼吸 not breathing 4.Seizure. 心脏骤停cardiac arrest,A Change From A-B-C to C-A-B,“Adults” Children infants (excluding the newly born),复苏步骤,VF-CA: 中心血液中富含氧 窒息性心脏骤停- 通气!,关键:CCC,心 脑,C-A-B,及早开始按压,关键,Forget CPR, Give CCR Instead,心脑复苏新概念Cardiocerebral Resuscitation,忘了CPR,代之

6、CCR,简化成人基本生命支持,: CCC+DF,胸外按压速率：每分钟至少 100 次*,2005（旧）：以每分钟大约 100 次的速率按压。,2010（新）： 以每分钟至少 100 次按压的速率 进行胸外按压较为合理 . (快 ! 不间断),胸外按压幅度*,2010（新）：应将成人胸骨按下至少 5 厘米,2005（旧）： 应将成人胸骨按下大约 4 至 5 厘米。,电击治疗ELECTRICAL THERAPIES,AED Use in Children Now Includes Infants 2010 (New): 1 year of age. 2005 (Old): Not use of A

7、EDs for infants 1 year of age.,CPR 3min 除颤 立即CPR,(不检查脉搏/心律分析),ADVANCED CARDIOVASCULAR LIFE SUPPORT,监测PETCO2 :,1.确定气管导管位置 2.监测CPR有效性 3.检查心跳恢复,CPR质量,药物New Medication Protocols,2010 (New): 阿托品不常规 用于PEA/心搏停止,2005 (Old):,阿托品用于高级心血管生命支持 心搏停止 缓慢PEA 可用阿托品,心动过速tachycardia,规律的单型 宽QRS 心动过速 腺苷 (rhythm is regula

8、r),2010 (New),adenosine 只用于规则的窄QRS 的折返性室上速,2005 (Old):,不规律的宽QRS 心动过速 不用腺苷 (may cause degeneration of the rhythm to VF),心动过缓Bradycardia,症状性不稳定心动过缓 变时性药物输注,atropine while awaiting a pacer or if pacing was ineffective. chronotropic drug infusions,2010 (New),2005 (Old):,避免过度通气Avoiding Hyperventilation,1

9、0 -12 次/min PETCO2 : 35 - 40 mm Hg PaCO2 : 40 -45 mm Hg.,ACLS Cardiac Arrest Algorithm,PostCardiac Arrest Care,谢谢!,Central Nervous Systembrain injury,Clinical manifestations : coma Seizures Myoclonus neurocognitive dysfunction (memory deficits to persistent vegetative state) brain death.,Seizure Man

10、agement,EEG should be monitored frequently or continuously in comatose patients after ROSC (Class I ),Neuroprotective Drugs,molecular events hours to days after ROSC therapeutic window neurodegeneration .,Prognostication of Neurological Outcome,Poor outcome is defined as Death persistent unresponsiveness inability to undertake independent activities after 6 months,Neurological Assessment,Physical examination 24 hours after cardiac arrest: NO signs motor response pupillary light corneal reflex