isishwankathelo
Ibhunga lolwandiso lwaseYurophu (i-ERC) kunye noluntu lwaseYurophu lweyeza lokukhathalela (i-ESICM) liye lasebenzisana nezi ziKhokelo zoKhathalelo lokuThumela kwakhona kubantu abadala, ngokuhambelana nenzululwazi kunye nonyango lwe-CPR. Izihloko ezigutyungelweyo zibandakanya i-syndrome ye-Pardiac, isifo sokuthinjwa kwentliziyo, ioksijini kunye nolawulo lwe-wiroden, ulawulo lobushushu, isisiseko, ukubuyisela kwimeko yesiqhelo, kunye Umncedisi womzimba.
Amagama aphambili: ukubanjwa kwentliziyo, ukubanjwa kwentliziyo, ukhathalelo lokubuyisa kwakhona, ukuxela, izikhokelo
Intshayelelo kunye nenqanaba
Ngo-2015, iBhunga lokuHamba loSula lwaseYurophu (i-ERC) kunye noluntu lwaseYurophu lweyeza lokukhathalela (i-ESICM) lisebenzisane nokukhulisa izikhokelo zokuqala zokudibana, ezazipapashwa ngokuvuselela kwakhona kunye neyeza lokukhathalela. Ezi zikhokelo zononophelo lwasemva kokubuyela umva zihlaziywa kakhulu ngo-2020 kwaye zibandakanya isayensi epapashwe ukusukela ngo-2015. Izihloko ezigutyungelweyo, ulawulo lobushushu olwenziwe kwi-Carntiac, ulawulo lweqondo lokuhlaselwa, i-progunosis, kunye Iziphumo zexesha elide (umzobo 1).
Isishwankathelo sotshintsho olukhulu
Unonophelo kwangoko
• Unyango lwasemva kokubeletha luqala kwangoko emva kweRoSC egciniweyo (ukubuyiswa kwendlela yokujikeleza kwe-spoentaneous), ngaphandle kwendawo (umzobo 1).
• Ukubanjwa kwentliziyo ye-Cardiac, kuqwalasela iZiko lokuThumela kwentliziyo. Fumana isizathu sokubanjwa kwentliziyo.
• Ukuba kukho ikliniki (umz. Ukungazinzi kwe-hemimomic) okanye ubungqina be-ECG ye-Ischemia, i-ongiography ye-coronary yenziwa kuqala. Ukuba i-angiography ye-ceronary ayichongi i-lesion yengozi, i-CT ye-CT ye-CT i-Angioty Pillmonity yenziwa.
Ukuchongwa kwangoko kokuphefumla okanye ukuphazamiseka kwe-neurologing kunokwenziwa ngokwenza isikali se-CT sobuchopho kunye nesifuba ngexesha lokulala esibhedlele, ngaphambi okanye emva kwe-angiography (jonga i-coronary properfusion).
• Yenza i-CT yengqondo kunye / okanye i-angiographic yemiphunga ukuba kukho imiqondiso okanye iimpawu zibonisa ukuba i-aurological okanye i-Endespitory ye-asystory, okanye i-heatropsions, okanye i-hypoxtia ebhalwe kwizigulana nge iimeko zokuphefumla eyaziwayo).
1. Inqwelo moya kwaye iphefumla
Ulawulo lwe-Airway emva kokujikeleza kwe-spontaneous ibuyiselwe
I-Airway kunye nenkxaso ye-ventilatory inkxaso kufuneka iqhubekeka emva kokubuyiselwa kwakhona kokujikeleza kwe-spoentaneous (iROSC).
• Abaguli abaye bakubanjwa kwentliziyo ye-Tread Cardiac, imbuyekezo kwangoko kwi-footrocheal ye-endonical, kodwa kufuneka inikwe ioksijini ngemaski yeoksijini ye-actgen engaphantsi kwe-94%.
• I-Tootrocheal Intubuyity kufuneka yenziwe kwizigulana ezihlala i-comatose emva kweRSC, okanye izigulana ezineempawu zeklinikhi ze-ventilation, ukuba ukungathathi ntweni kwe-Endotracheal akwenziwanga ngexesha le-CPR.
• I-Tootrocheal Intubuyity kufuneka yenziwe ngumqhubi onamava ngomgangatho ophezulu wempumelelo.
Ukubekwa ngokuchanekileyo kwetyhubhu ye-endotracheal kufuneka kuqinisekiswe ngokwenza i-caveforgraphy.
• Ngaphandle kokungabikho kwe-endotrocheal ye-extracheal, kusengqiqweni ukufaka i-sumaway yomoya (SGA) okanye ukugcina inqwelo moya usebenzisa iindlela ezisisiseko kude kubekhona umntu onesidima.
Ulawulo lweoksijini
• Emva kwe-ROSC, i-100% (okanye i-oxymuged) isetyenziselwa i-acyrial osterial oxygen, i-acterial ye-acterial ye-oxygen ye-oxygen ingalinganiswa ngokuthembekileyo.
Nje ukuba i-Arterial Ortial Asterial Artegen inokufumaneka ngokuthembekileyo okanye ixabiso legesi legazi elinokuthi lifumaneke, ioksijini ephefumlelweyo ihlawulwe ukufezekisa ubugcisa beoksijini yeoksijini (pao2) ye-10 ukuya kwi-13 I-KPA okanye i-75 ukuya kwi-100 mmhg (umzobo 2).
• 避 避 I-ROSC 后的低氧血症 (Pao2 <8 KPA 或 60 mmhg).
• Kulumkele i-hyperxemia emva kweRoSC.
Ulawulo lwe-ventilation
Fumana i-GAPSE yegazi le-Arterial kwaye usebenzise ukubeka iliso kwi-CO2-tidal CO2 kwizigulana ezingena moya.
• Ukuze izigulana ezifune ukungena koomatshini emva kokuba iRSC, ihlengahlengise umoya wokufezekisa uxinzelelo oluqhelekileyo lwe-carbon diokb diokside (i-Paco2) ye-4.5 ye-15 ukuya kwi-45 mmhg.
I-Paco2 ijongwa rhoqo kwizigulana ezinyangwa ngolawulo lobushushu olujolisiweyo (i-TTM) kuba i-hypocapnia inokwenzeka.
Amaxabiso erhasi yegazi ahlala elinganiswa esebenzisa ubushushu okanye iindlela zokulungisa ukulungisa amaqondo ngexesha le-TTM kunye neqondo lobushushu eliphantsi.
• Ukwamkela isicwangciso-nkqubo esikhuselweyo sokukhusela umoya sokukhusela ukufezekisa umthamo we-tidal of 6-8 ml / kg wobunzima bomzimba ofanelekileyo.
2. Ukujikeleza kweCoronary
Hlaziya kwakhona
• Izigulana zabantu abadala ezineROSC zilandela ukrokrela ukubanjwa kwentliziyo kunye nokuphakamisa i-ECG kufuneka kwenziwe uvavanyo lwelebhu engxamisekileyo kwi-Cardiac Carentity (PCI kufuneka yenziwe ngokukhawuleza).
• Uvavanyo lweLebhu lwe-Cardiac Careatory kufuneka luthathelwe ingqalelo kwizigulana ezine-rosc ezino-gosc of Tod-Off-Off-One I-hamugonamic kunye / okanye izigulana ezingazinzanga zombane).
Ukubeka iliso kunye noLawulo
• Ukuqhubeka nokubekwa kweliso kuxinzelelo lwegazi ngokusebenzisa i-arterious ye-ductus kufuneka kwenziwe kuzo zonke izigulana, kwaye i-Cardiac Expatments Iphuculo isengqiqweni kwizigulana ezingazinzanga.
• Yenza i-echocardiogram kwangoko (ngokukhawuleza) kuzo zonke izigulana ukuba zichonge naziphi na iimeko zentliziyo eziphantsi kwaye zithathe inqanaba lokungasebenzi kakuhle.
• Kulumkele ukuHypoten (<65 mmhg). Ithagethi ithetha uxinzelelo lobugcisa (imephu) yokufezekisa iziphumo ezaneleyo zonyulo (> i-0.5 ml / kg * h kunye ne-HCTE okanye incitshisiweyo (umfanekiso 2).
• I-BradyCardia ingashiywa ingalawulwa nge-TTM nge-33 ° C ukuba uxinzelelo lwegazi, i-lactate, i-CCVE2, okanye i-SCE2 zanele. Ukuba akukhange kubenjalo, cinga ukwandisa ubushushu ekujolise kuyo, kodwa ungaphezulu kwe-36 ° C.
• Ukufakwa kolondolozo kunye nolwelo, i-norepinephrine, kunye / okanye i-Dobuntune ngokuxhomekeke kwimfuno yevolumu ye-intravascular, i-vasococcation, okanye isigulana semisipha kwisigulana somntu ngamnye.
• Kulumkele i-hypokamia, enxulunyaniswa ne-ventricular ifiythmias.
• Ukuba ukuvuselelwa kwamanzi, ukuguqula kwemisipha, kunye nonyango lwe-vascoive ayonelanga, inkxaso ye-vascoory (umz. ukungaphumeleli kwe-ventricular. Ukushiywa kwe-ventricular ye-ventricular okanye i-overcorporalporeal gonsovascular ye-endovascular kufuneka ithathelwe ingqalelo kwizigulana ezine-haightonary syndrome (i-ACS) kunye nokuphinda-phinda i-bictycarcia (VT), ngaphandle kokhetho lonyango.
3. Umsebenzi wemoto (qinisekisa ukubuyiswa kwe-neurological)
Ukulawulwa kokulawula
• Sicebisa ukusetyenziswa kwe-Electroencephalograph (i-EEG) ukufumanisa i-elektrose kwizigulana ezinonyango lwekliniki kunye nokubeka iliso kwimpendulo kunyango.
• Ukunyanga ukubanjwa emva kokubanjwa kwentliziyo, siphakamisa i-levetiracetam okanye i-sodium Voitileate njengeziyobisi ze-antiepileptic zokuqala ukongeza kumayeza e-sedative.
• Sicebisa ukungasebenzisi i-prophylaxis yokutsala izigulana emva kokubanjwa kwentliziyo.
Ulawulo lobushushu
• Abantu abadala abangaphenduli kwi-OHCA okanye kwi-Cardiac yentliziyo yesibhedlele (nasiphi na isingqisho sentliziyo), siphakamisa ulawulo lobushushu olujolisiweyo (TTM).
• Gcina ubushushu ekujolise kuyo kwixabiso elipheleleyo phakathi kwama-32 nama-36 ° C ubuncinci iiyure ezingama-24 ubuncinci.
• Kwizigulana ezihlala i-comatose, zithintela umkhuhlane (> 37.7 ° C) ubuncinci iiyure ezingama-72 emva kweRoSC.
• Musa ukusebenzisa isisombululo se-prehoppitas ebandayo kwiqondo lokushisa elincinci. Ulawulo ngokubanzi lononophelo ngokubanzi-Ukusetyenziswa kwe-sedives ene-optiting kunye nee-opioids.
• Ukusetyenziswa kwesiqhelo kokubhalwa kwe-neuromuscular vicks ithintelwa kwizigulana ezine-TTM, kodwa zinokuqwalaselwa kwiimeko ze-chills ezinzima ngexesha le-TTM.
• Uxinzelelo lwe-ircecer prophylaxis lubonelelwa rhoqo kwizigulana ezinamatyala eCardiac.
Ukuthintela i-verissis enzulu.
• 如果需要, 使用胰岛素输注将血糖定位为 7.8-10 mmol / L (140- 180 MG / DL), 避 避 低血糖 (<4.0 MMOL / L (<70 mg / dl).
• Qalisa ukutya okuthintelwa kwexabiso eliphantsi (ukondla kwesondlo) ngexesha le-TTM kunye nokunyusa emva kokuvuselela kwakhona ukuba kuyafuneka. Ukuba i-TTM ye-36 ° C isetyenziswa njengeqondo lokushisa, ireyithi yokondla i-inveral inokunyuka kwangoko ngexesha le-TTM.
• Asiphakamisi ukusetyenziswa kwesiqhelo sezinto ezibonisa iintsholongwane.
4. Uqikelelo oluqhelekileyo
Izikhokelo ngokubanzi
• Asikucebisi ii-antibioctic zezigulana ezingazi nto ukusuka ekubanjweni kweCadiac, kwaye i-neuroprograsis, kunye nokucingisisa, kunye nokunceda unyango ekuhlaleni amathuba okufezekisa ukubuyiswa kwe-neurical enentsingiselo (umzobo 3).
• Akukho ntetho inye i-100% ichanekile. Ke ngoko, sicebisa isicwangciso esiliqili se-multionady ye-multional "
• Xa kuxela iziphumo ezingalunganga ze-Nourological, ubunyani obuphezulu kunye nokuchaneka kuya kufuneka ukuphepha uqikelelo lobuxoki.
Uviwo lwe-neurological lwekliniki lubalulekile kwi-prograsis. Ukuthintela ukuqikelela ngempazamo, abagqirha kufuneka bakuphephe ukudanisa okunokubakho kweziphumo zovavanyo ezinokuba neento ezinokubakho nge-sedtives kunye namanye amayeza.
• Uvavanyo lweklinikhi lwalo mhla luyekelelwe xa izigulana ziphathwa nge-TTM, kodwa uvavanyo lwe-progranonolojintolo lokugqibela kufuneka lwenziwe emva kokuvuselela kwakhona.
• Unyango kufuneka luye lwazi umngcipheko wesiprofetho sokuzibamba, okwenzeka xa kusenziwa iziphumo zesalathiso ezibonisa iziphumo ezigwenxa kusetyenziswa kwizigqibo zonyango, ngakumbi ngokubhekisele kunyango oluzinzileyo.
Injongo yovavanyo lwe-neuroprograsis yesalathiso yesalathiso kukuvavanya ubuqhetseba be-hypoice-schemic ububi bengqondo. I-neuroprograsis yenye yeenkalo ezininzi ekufuneka ziqwalaselwe xa zixoxa ngokubaluleka komntu ukuze ziphinde zifumaneke.
Imodeli yemodeli emininzi
• Qalisa uvavanyo lwethenda lovavanyo oluchanekileyo lweklinikhi, lwenziwa kuphela kwizinto ezinkulu ezixineneyo (umz.
• Ngaphandle kokungabikho kwabaguli, abaguli abanee-ROSC ≥ M≤3 kwiiyure ezingama-72 kungenzeka ukuba babe neziphumo ezimbi ukuba zimbini okanye ngaphezulu kwezi meko zimbonakalo ye-N20 ye-N20 SSEP ≥ I-24 h, Inqanaba eliphezulu le-EEG> 24 h, i-NEUREAL EZENUSE (NSE)> 60 μg / i-42 h Uninzi lwale miqondiso lungabhalwa ngaphambi kwe-72 h leRos Ros; Nangona kunjalo, iziphumo zazo ziya kuvavanywa kuphela ngexesha lovavanyo oluqinisekileyo lweklinikhi.
Uviwo lweklinikhi
Uviwo lweklinikhi luchaphazeleka ekuphazamiseni kwi-sedives, ii-opioids, okanye abahlaziyi bomsipha. Inokwenzeka ukuba inokwenzeka i-sadotion yentsalela kufuneka ihlale ithathelwe ingqalelo kwaye ikhutshiwe.
• Ukuze abaguli abahlala kwiiyure ezingama-72 okanye kamva emva kweROSC, ezi mvavanyo zilandelayo zinokuqikelela intetho ye-neuronogical.
• Kwizigulana ezihlala i-comatose iiyure ezingama-72 okanye kamva emva kweROSC, ezi mvavanyo zilandelayo zinokuxela kwangaphambili iziphumo ezibi zemithambo:
-Ukungabikho kwe-Bilatal Receting Shopx
-I-bouritivery encinci
-Ukuphulukana ne-conneal cofx kumacala omabini
- I-Myoclous ngaphakathi kweeyure ezingama-96, ngakumbi i-MyCloclonus kwiiyure ezingama-72
Sikwacebisa ngokurekhoda i-EEG phambi kweentsomi ze-myoclonic ukwenzela ukufumana nayiphi na into enxulumene ne-ETEG okanye ichonge imiqondiso ye-EGG, njengempendulo ye-EGG, iphakamisa ukubakho kwe-neurological.
neurophysiology
I-EEG (i-electroencedphaGragram) yenziwa kwizigulana ezilahlekelwe yingqondo emva kokubanjwa kwentliziyo.
• Iipateni ze-EEG ze-EEG zibandakanya imvelaphi yokucinezelwa okanye ngaphandle kokusebenza ngamaxesha ngamaxesha kwaye kunikezelwe. Sicebisa ukuba sisebenzise ezi patheni ze-EEG njengesalathiso sento engeyiyo emva kokuphela kwe-TTM nasemva koko.
• Ubukho bokuxhuzula ngokuchazayo kwi-EEG kwiiyure ezingama-72 zokuqala emva kokuba iRosc yisalathiso se-prognosis esingalunganga.
• Ukunqongophala kwempendulo yangasemva kwi-EEG yisalathiso se-prognosis esingalunganga emva kokubanjwa kwentliziyo.
• Ukulahleka kwe-chilateral ye-somatosens
Iziphumo ze-EEG kunye ne-somatosenstory evulekileyo (i-SSEP) zihlala ziqwalaselwa kwimeko yovavanyo lweklinikhi kunye nezinye iimviwo. I-Neuromuscular ibhloko yokubhloka kufuneka ithathelwe ingqalelo xa i-SSE yenziwe.
I-Biomarkers
• Sebenzisa uluhlu lwemilinganiselo ye-NSE ngokudibeneyo nezinye iindlela zokuqikelela iziphumo emva kokubanjwa kwentliziyo. Amaxabiso aphakamileyo kwiiyure ezingama-24 ukuya kwezingama-48 okanye iiyure ezingama-72, zidityaniswe namaxabiso aphezulu kwiiyure ezingama-48 ukuya kwezingama-72, zibonise i-prognosis engalunganga.
Ukucinga
• sebenzisa ingcinga yokucinga ngengqondo ukuqikelela iziphumo ezingalunganga ze-neurological emva kokubanjwa kwentliziyo ngokudibeneyo kunye nezinye izinto eziqingqiweyo kumava afanelekileyo ophando.
• Ubukho be-Edema yeCerebral Ajikelele, ibonakaliswe ngokuncitshiswa okutshintshiweyo kwi-GY
• Ukucinga okufunyenweyo kuhlala kuthathwa njengendibaniselwano nezinye iindlela zokuqikelela i-neurological progunosis.
I-5. Yiyeke unyango lokuxhasa ubomi
• Ingxubusho eyahlukileyo yovavanyo lwePrognoarsis yokurhoxa kunye nokubuyiswa kwe-neurolocal yonyango lokuxhasa ubomi (WLst); Isigqibo se-WLST kufuneka sithathele ingqalelo imiba yengqondo ngaphandle kokulimala kwengqondo, njengabudala, ukunxibelelana, umsebenzi wenkqubo, kunye nokukhetha ngomonde.
Yabela ixesha elifanelekileyo lonxibelelwano, i-prognosis yexesha elide emva kokubanjwa kwentliziyo
Inqanaba lonyango ngaphakathi kweqela lichaza kwaye liqhuba uvavanyo lomzimba kunye nongeziyolo ezingenamsebenzi kunye nezalamane. Ukufunyanwa kwangoko kweemfuno zohlengahlengiso zokuthintela umzimba ngaphambi kokuba ukhunjulwe kunye nokubonelela ngeenkonzo zokubuyisela kwimeko yesiqhelo xa kufuneka. (Umzobo 5).
• Lungelelanisa utyelelo lokulandela ukulandela
- 1. Isikrini seengxaki zokuqonda.
2. Isikrini seengxaki zemozulu kunye nokudinwa.
3. Nika ulwazi kunye nenkxaso kwixhoba kunye neentsapho.
I-6.
Zonke izigqibo malunga nomsebenzi wezinto ezizezomthetho ziya kuthobela iimfuno zomthetho nezokuziphatha.
• Umrhumo wengcaciso kufuneka uqwalaselwe abo badibana neRosc kwaye bahlangabezane neekhrayitheriya zokufa kwe-neurological (umzobo 6).
• Kwizigulana ezihlangwini ezinomdla ezingafezekisi iikhrayitheriya zokufa, umnikelo ofanelekileyo kufuneka zithathelwe ingqalelo ngexesha lokugcina izinto ezijikelezayo ukuba isigqibo senziwe ukuqalisa ukuphelisa inkxaso yobomi kunye nokuyeka inkxaso yobomi.
Ixesha lasemva kwexesha: Jul-26-2024