Title: ?????????? Cardiac arrest and sudden cardiac death
1??????????Cardiac arrest and sudden cardiac death
2? ? ? ? (Cardiac Arrest,CA)
? ?????????? ????????????? ??,??????????????????
?????,????,?????????,??????
3?????Sudden cardiac death
- ???????1?????????????????????????????
- Natural
- Rapid
- Unexpected
-
4???????
5???????
- 1.?????,????
- ??????
- ?????????
- ???????
- ????
6??????????????
? ??? (?80)????????????????????????? ?
????????????????????????????????????? ? ????
???Q-T?????Brugada???? ??????????
7???????
? ?!
8????????????
? CO2???????? ? ?????????????? ?
??????????
???????????,ATP????????????1/191/20??????,?
????????46???????????,???????,??????????
9????????????
? ???????? 46min,?? 1015min ??
2030min,????? 60min ? ??????30min ?
???12h ? ?????
10????4???
- ??? Prodromal symptoms
- ????? Onset of the terminal event
- ???? Cardiac arrest
- ????? Biological death
11? ? ? ? (Cardiopulmonary Resuscitation, CPR )
???????????????????????????????????????????
12??????????????????!
lt4?? 50????
4-6?? 10????
gt6?? ????4
gt10?? lt1
13???????
- ? ??????CA?1200?2/3??1h????
1/2??????????1.2-1.4? - ? ???????CA?????60,???1-2??????50,???50??16.6
??,?25-30??? - ? ????????????,CA????10,?87.8??????
- ? ??????????1?3500-4000???,??1??
14?????
15???????
? ???????????????? ? ????????????????,????? ?
1984?AHA??????????????(Cardiopulmonary
cerebral resuscitation, CPCR)?
16CPR???
- 1956? Zoll ?????????????????,??????????
- 1958? Peter Safer???????????,?????????????????????
???? - 1960? William Kouwenhoven ?????1????????????,????
????????
17???????????????
- ??1974,1980,1986,1992
- ?? 1992,1996,1998
- 1992????????????(ILCOR)
- 2000? AHA?ILCOR????????(CPR)??????(ECC)??,???????
? - 2005? AHA?ILCOR??????2005CPR? ECC????
- 2010?AHA ????CPR??
18???????
19- ?????????( ?????)???????10??,
?10???????????,?????
20??CA???????
- ? ???????????????????????,
- ?????CPR
- ? ??????????????
- ? ?????????????????????
- ? ???????????????
21????????
- ???????????????????
- ??????????
22?????? ( Basic life support, BLS )
- ????(Airway)
- ????(Breath)
- ????(Circulation)
- 2010?AHA???C ? A B
23??????
- ???????????
- ???? ??100?/?
- ?????????
- ???? 5cm
- ???????30 2
24???????
- ??/????302
- ????????????????
- ????(2???1?)????????
25 ?????????( A)
??????????? ??,?????????,????,????510?
????? ????
26??????????????
27??????
??????????? ???????? ??????????? ?????????10?
28????(B)
- ???????,??1?
- ??????????,????
- ???????,?????????
- ???????????
- ????1012?/min (lt8??1220?/min )
29???????
30????????????????
- 2007?Lancet(???)???????????????,????????,???????
? - Gordon Ewy ????????????????????40?!
- ????????????????????????CPR??,????????????
(6.2?3.1)? - ????????????????????????,???????
- ???????????
31???? (D)
?????(AED)
32???????
- ? ?????????????????
- ? ??????VF??????
- ? ???????,????????????
33??????
- ?????,????
- ?????(???????)???
- ????
- ??
- ??
34????
? ??( 8?) ???????360J ???
150200J(??) (class IIa) ? ??
???2J/Kg ??????4J/Kg
35- ? ?????????,???CPR (class IIa) 2min? CPR 302
5 ??????,?????????? (class IIb)
36????????
- ????
- ????
- ??????
- ????
- ???????
37???????
- ????????? ??????????????????????30???,????????
?????????(1)???????(2)??????(3)??????(4)??????
? (5)??????? - ?????????????,??????????????????????????????????
38?????? (Advanced life support, ALS)
- ?????????
- ?????????,????
- ??????,??,???????
- ???????????
- ????ICU??????????????
39?????
- ?????????(100),???????????????????
- ????????????????
- ????????????????????,??????30??
40????/??????
- ??????????????????????
- ???????????????,??????
- ??????1995???????????,??????????,???????(?b)
- ???????????????,????????,?????????(????)
41????
- ????????????,1mg iv,?3-5??1?,?????????5mg
- ??????1mg???????,????40 IU?????1?
- ?????????????????????????
42??????????
???(????)?? 150mg ?? iv ,
5GS 44ml ??? 300mg / 3ml/h ???? ??????
1-1.5mg/kg iv, 3-5?????,
???NS 25ml ???? 500mg/ 6ml/h ???? ß?????
???? 5mg iv,
????0.5mg/kg iv ???1-2g ??,
43???????
- ????
- ????????????????,1mg iv,?3-5???????
- ?????
44????????
- ????????????,?????????
- ???? 1 mmol/kg (5????100ml60mmol),
- ??15??????,????????????
- ???????????????????
- ????????????
-
45???????
- ???????????????
- ?????????,??33-34 ?
- ?????????????,????DXM
- ???????????????????????
- ?????
- ??????????????
46? ?!