心跳驟停后亞低溫治療PPT學(xué)習(xí)教案

1、會(huì)計(jì)學(xué)1心跳驟停后亞低溫治療心跳驟停后亞低溫治療Effects of mild hypothermia on hemodynamics in cardiac arrest survivors and isolated failing human myocardium.Claudius Jacobshagen.Clin Res Cardiol (2010) 99:267276第2頁(yè)/共56頁(yè)Resuscitation 102 (2016) 5156第3頁(yè)/共56頁(yè)Resuscitation. 2016 May;102:51-6第4頁(yè)/共56頁(yè)SOS-KANTO study group. Lanc

2、et.2007; 367:920926第5頁(yè)/共56頁(yè)第6頁(yè)/共56頁(yè)第7頁(yè)/共56頁(yè)HACA 2002 Bernard 2002Idrissi 2001第8頁(yè)/共56頁(yè)Resuscitation 51 (2001) 275281第9頁(yè)/共56頁(yè)The Hypothermia after Cardiac Arrest Study Group. N EnglJ Med 2002; 346:549556Berrard SA,Gray TW, Buist MD, et al. N Engl J Med 2002;346:557563.第10頁(yè)/共56頁(yè)Cerebral Performance Cat

3、egory (CPC)CPC 1Good cerebral performanceCPC 2Moderate cerebral disabilityCPC 3Severe cerebral disabilityCPC 4Coma or vegetative stateCPC 5Brain deathPositive OutcomesNegative Outcomes第11頁(yè)/共56頁(yè)低溫的對(duì)象，目標(biāo)溫度，持續(xù)時(shí)間，復(fù)溫第12頁(yè)/共56頁(yè)第13頁(yè)/共56頁(yè)American Journal of Emergency Medicine (2011) 29, 148154第14頁(yè)/共56頁(yè)Americ

4、an Journal of Emergency Medicine (2011) 29, 148154第15頁(yè)/共56頁(yè)Circulation. 2012;126:2826-2833第16頁(yè)/共56頁(yè)Niklas Nielsen, M.D., Ph.D.第17頁(yè)/共56頁(yè) 排除標(biāo)準(zhǔn) 從自主循環(huán)恢復(fù)到監(jiān)測(cè)超過240min 以起始節(jié)律為心臟停搏的非目擊心跳驟停 懷疑或明確急性顱內(nèi)出血或卒中 體溫低于30n engl j med 369;23 december 5, 2013 2197第18頁(yè)/共56頁(yè)N Engl J Med. 2013 ;369(23):2197-206第19頁(yè)/

5、共56頁(yè)第20頁(yè)/共56頁(yè)第21頁(yè)/共56頁(yè)第22頁(yè)/共56頁(yè)第23頁(yè)/共56頁(yè)LOE B-R (randomized studies) and B-NR (nonrandomized studies) as well as LOE C-LD (limited data) and LOE C-EO (consensus of expert opinion)心臟驟停后目標(biāo)溫度管理專家共識(shí)中華急診醫(yī)學(xué)雜志，2016,8（25），1000-1006第24頁(yè)/共56頁(yè)第25頁(yè)/共56頁(yè)缺血再灌注再灌注ROS炎癥因子線粒體功能血管功能障礙血管功能障礙低血壓低血壓器官功能障礙器官功能障礙血腦屏障破壞血腦屏

6、障破壞腦水腫腦水腫亞低亞低溫溫心臟驟停后目標(biāo)溫度管理專家共識(shí)中華急診醫(yī)學(xué)雜志，2016,8（25），1000-1006第26頁(yè)/共56頁(yè)第27頁(yè)/共56頁(yè)Fukuda Journal of Intensive Care (2016) 4:30第28頁(yè)/共56頁(yè)第29頁(yè)/共56頁(yè)第30頁(yè)/共56頁(yè)第31頁(yè)/共56頁(yè)第32頁(yè)/共56頁(yè)第33頁(yè)/共56頁(yè)第34頁(yè)/共56頁(yè)不同的降溫設(shè)備不同的降溫設(shè)備及并發(fā)癥無差別及并發(fā)癥無差別Clin Res Cardiol. 2013 Aug;102(8):607-14第35頁(yè)/共56頁(yè)Contemporary practices in postcardiac a

7、rrest syndrome: the role of mild therapeutic hypothermia.Gerasimos Gavrielatos,Ther Adv Cardiovasc Dis(2010) 4(5) 325-333第36頁(yè)/共56頁(yè)第37頁(yè)/共56頁(yè)第38頁(yè)/共56頁(yè)JAMA. 2014 Jan 1;311(1):45-52. doi: 10.1001/jama.2013.282173.第39頁(yè)/共56頁(yè)第40頁(yè)/共56頁(yè)第41頁(yè)/共56頁(yè)第42頁(yè)/共56頁(yè)停止輸液條件 reached 33C or if pulmonary edema was suspected第

8、43頁(yè)/共56頁(yè)第44頁(yè)/共56頁(yè)第45頁(yè)/共56頁(yè)第46頁(yè)/共56頁(yè)快速輸液使右房壓增加，快速輸液使右房壓增加，降低了冠脈灌注壓，且可降低了冠脈灌注壓，且可以導(dǎo)致肺水腫以導(dǎo)致肺水腫心臟溫度低使得對(duì)除顫反應(yīng)性差心臟溫度低使得對(duì)除顫反應(yīng)性差，這一點(diǎn)有爭(zhēng)議，這一點(diǎn)有爭(zhēng)議第47頁(yè)/共56頁(yè)第48頁(yè)/共56頁(yè)DOI 10.1186/s13049-015-0121-3第49頁(yè)/共56頁(yè)n凝血功能障礙n感染風(fēng)險(xiǎn)增加第50頁(yè)/共56頁(yè)Kees H Polderman.Hypothermia and coagulation. Critical Care 2012, 16(Suppl 2):A20 Hypothermia and coagulation， Critical Care 2012第51頁(yè)/共56頁(yè) Mongardon N. Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era. Crit Care Med. 2011;39:13591364Tsai MS. Infections in the survivors of out-of-hospital