心肺复苏术|教你把握黄金四分钟!

2016-07-07 佚名 健康界

​心脏性猝死发病迅疾、病死率高,全社会应提高对其的认识水平,掌握基础心肺复苏技能,从容应对死神的挑战,尽可能地挽救生命、守护健康。 近些年来,“心脏性猝死”这一可怕的名词频频见诸报端。从青春少年到迟暮老人,从孱弱病体到运动健将,似乎都有可能在转瞬之间发生猝死,离我们而去;大多数人面对这样的残酷现实除了惊讶和叹息之外,往往感觉到无能为力。那么,到底心脏性猝死有多么可怕,我们普通老百姓面对猝死病

​心脏性猝死发病迅疾、病死率高,全社会应提高对其的认识水平,掌握基础心肺复苏技能,从容应对死神的挑战,尽可能地挽救生命、守护健康。

近些年来,“心脏性猝死”这一可怕的名词频频见诸报端。从青春少年到迟暮老人,从孱弱病体到运动健将,似乎都有可能在转瞬之间发生猝死,离我们而去;大多数人面对这样的残酷现实除了惊讶和叹息之外,往往感觉到无能为力。那么,到底心脏性猝死有多么可怕,我们普通老百姓面对猝死病人又该怎么做呢?



“心脏性猝死”是一个沿用了数百年的名词,如今公认的定义是指急性症状发作后1小时内发生的以意识突然丧失为特征的由心脏原因引起的自然死亡;其中发病急骤、不可预料和自然死亡是诊断心脏性猝死的3个关键点。在我国,心脏性猝死的年发生率为41.84/10万,考虑到13亿的人口基数,每年心脏性猝死的发病人数高达54.4万人,位居全球各国之首。在院外发生的心脏性猝死当中,80%发生于家中,15%发生于公共场所,40%发病时没有他人在场。在猝死人群中,发生在大学、中学、小学甚至幼儿园的青少年猝死尤其值得关注,在美国,儿童猝死率为0.6-6.2/10万/年,其中20-25%猝死发生在运动中,这一数据可谓触目惊心。
 
心脏性猝死的原因相当复杂,常见的包括急性心肌梗死、恶性心律失常、心力衰竭、扩张型心肌病、肥厚型心肌病、瓣膜病、先天性心脏病以及不明原因猝死等。除此之外,剧烈撞击、吸毒、酗酒、滥用药物等也是心脏性猝死不可忽视的原因。一般而言,在12岁以下儿童先天性心脏病和原发性心电疾病占主导,18岁以上的成年人则以心肌病、冠心病和心律失常为主、竞技性运动员可能以肥厚型心肌病、冠状动脉畸形及心律失常为主。
 
猝死发生迅速、后果严重,因此,如果能够早期筛查除心脏性猝死高危人群,给予必要的监护和预防措施,可能会挽救很多人的生命。

具有以下表现的人可能需格外警惕猝死的风险:



(1)有高血压、高血糖、高血脂等基础疾病;
(2)活动后心悸、胸闷、胸痛伴活动耐量下降;
(3)曾有晕厥发作史;
(4)家族中有猝死患者或者肥厚性心肌病、扩张型心肌病、致心律失常性右室心肌病、LQT、CPVT等疾病患者;
(5)长期吸烟及饮酒史;
(6)心电图上可见QT间期延长、Epsilon波、碎裂QRS波、Brugada波、早复极等表现。

心脏性猝死救治的成功率过去美国仅为8%,欧洲为5%,这一数据在发展中国家甚至不足3%。近年来,随着公众心肺复苏知识和技能的提高,以及大量公共场所AED的装备与应用,在美国急救设施配备较好的地区院外猝死抢救成功率已升至50%以上。在心肺复苏的最新要求中,黄金4分钟的理念受到越来越多的重视。所谓黄金4分钟,即指应该努力在4 min内开始初级心肺复苏。统计数据表明,如果能够在猝死发生4分钟之内进行除颤治疗,心脏性猝死患者生存率可提高到60%到75%;而如果在间隔较长时间之后才得到电除颤或胸外按压治疗,救治的成功率仅为15%。因此,对于心脏性猝死的病人,如果能在医务人员到来之前,及时展开施救,将挽救很多人的生命。

当我们目睹身边人突然到底、呼之不应,怀疑猝死的时候,应该迅速且有条不紊地进行以下

抢救措施:

(1)判断周围环境,将患者转移到开阔的平地上开展抢救,同伴呼叫救护车;


(2)通过拍打、呼叫病人判断是否意识丧失,如接受过专业培训可以通过检查胸廓起伏、颈动脉搏动判断是否有心跳、呼吸;


(3)尽早开始胸外按压,操作者两手掌重叠交叉置于患者胸骨中下段,双肘关节伸直,利用身体重力有节奏地垂直向下按压,将胸骨下段压下5cm以上,而且要保证胸廓充分回弹,按压频率在100次/分以上;

(4)开放并清理气道后开始人工呼吸,用手捏住患者鼻孔,深吸气后贴紧患者口唇外缘用力吹气,胸外按压与通气比例为30:2,如果同伴在场可两人交替进行;



(5)如果周围有AED,尽快分析心律,开始除颤;



(6)初级心肺复苏后尽快转移至专业医疗机构进行高级心肺支持。
 
对于心脏性猝死高危患者,早期预防可以明显提高存活率。

在冠心病患者当中,戒烟、适量运动、降脂治疗、控制糖尿病及降压对于预防心脏性猝死十分重要,对于已罹患冠心病的患者进行血运重建并长期应用冠心病二级预防药物。先天性心脏病、风湿性瓣膜病患者应尽早行介入或外科手术治疗。各种缓慢型心律失常患者必要时应行心脏起搏器植入,快速型心律失常应接受规范的药物治疗或导管消融,同时要注意去除各种诱因:如纠正电解质紊乱 ( 尤其是低、高血钾症 ),保持情绪稳定和生活规律,减轻工作压力等。对于有恶性室性心律失常或有猝死风险的患者,ICD 是目前预防心脏性猝死最有效的方法,在充分评估患者猝死风险及危险分层后可考虑植入。

心脏性猝死发病迅疾、病死率高,全社会应提高对其的认识水平,掌握基础心肺复苏技能,从容应对死神的挑战,尽可能地挽救生命、守护健康。

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    2016-11-21 aids222
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    2016-08-17 doctorJiangchao

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    2016-08-17 doctorJiangchao

    继续关注路

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    2016-07-09 lizhou0204

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