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AHA 2014：创伤和心搏骤停的挽救治疗进展

2014-12-05 高晓方 译 医学论坛网

创伤心搏骤停AHA2014
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挽救治疗包括主动脉血流阻断、体外膜式氧合(ECMO)和体外生命支持(ECLS)，并被用于标准治疗失败心跳骤停和创伤患者的复苏。AHA 2014复苏科学座谈会与会专家对何时以及如何应用挽救治疗进行了探讨。 美国布鲁克陆军医学中心Berry博士表示，对出血性休克应用挽救治疗时，穿透伤和钝伤患者的生存率分别为7%和1%，并且生存者中有15%伴有神经功能缺损。同时他认为，血管内球囊主动脉闭塞(R

挽救治疗包括主动脉血流阻断、体外膜式氧合(ECMO)和体外生命支持(ECLS)，并被用于标准治疗失败心跳骤停和创伤患者的复苏。AHA 2014复苏科学座谈会与会专家对何时以及如何应用挽救治疗进行了探讨。

美国布鲁克陆军医学中心Berry博士表示，对出血性休克应用挽救治疗时，穿透伤和钝伤患者的生存率分别为7%和1%，并且生存者中有15%伴有神经功能缺损。同时他认为，血管内球囊主动脉闭塞(REBOA)可用于伴有进行性出血并且血流动力学无应答或一过性应答的创伤或心跳骤停患者。

美国莱加西伊曼纽尔医院Wanek博士指出，如果通过适当膜肺部分体外循环，终末期休克肺综合征可能具有可逆性。现代ECMO技术较过去更为小型化并且更易置入，从而使该治疗的广泛应用成为可能；其适应证包括可逆原因所致的心血管崩溃、呼吸衰竭、严重气道创伤、低体温和肺栓塞。

美国明尼苏达大学Yannopoulos副教授指出，指南推荐对院外心跳骤停患者的梗塞相关动脉实施急诊血管造影和迅速血运重建。延长心肺复苏（CPR）可实现更佳灌注，因此自动CPR装置的广泛应用可使转院更为容易。早期再灌注可降低肌钙蛋白水平并显著限制左室功能障碍。

英国布里斯托大学Lockey教授表示，穿透伤患者转送医院治疗的死亡率接近100%，这提示早期现场急救具有重要意义。对于穿透伤患者，现场开胸患者的生存率可达18%，有利于存活和良好神经转归的因素为心包填塞后5分钟内实施开胸术。

Experts evaluate salvage therapies for trauma and cardiac arrest. Daily News November 16, 2014



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    2014-12-07 zhaohui6731

    #AHA#

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    2014-12-07 ms920641618706883

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    2014-12-07 shenxlcyp

    #心搏骤停#

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    2014-12-07 drwjr

    #挽救治疗#

    0

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