在心脏骤停后的护理期间,血压目标和管理
Markus B Skrifvars1, Koen Ameloot2, Anders Åneman3
1Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland, Meilahden Sairaala, Haartmaninkatu 9, 00029 HUS, Finland.
Resuscitation
|June 28, 2023
概括
在心脏骤停患者中准更高的平均动脉压 (MAP) 似乎是安全的,尽管对显著益处的证据是不确定的. 未来的研究应该探索更广泛的MAP差异和非心脏骤停的原因.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 神经学 神经学
背景情况:
- 血压管理对于心脏骤停后的重症监护室患者至关重要.
- 目前的指导方针建议目标是平均动脉压 (MAP) 超过65-70mmHg.
- 需要血管压缩剂的低血压影响了近50%的这些患者.
研究的目的:
- 在心脏骤停后的护理中评估最佳的平均动脉压 (MAP) 目标.
- 分析现有证据,比较较低与较高的MAP目标.
- 为了告知未来的研究方向在心脏骤停后管理血压.
主要方法:
- 贝叶斯对四项涉及1000多名患者的研究进行了贝叶斯元分析.
- 研究比较了心脏骤停幸存者的不同平均动脉压 (MAP) 目标.
- 该分析评估了治疗效应和潜在危害的概率.
主要成果:
- 两组之间实现的MAP的差异在10-15 mmHg之间.
- 一项元分析表明,未来研究将发现显著的治疗效果 (>5%的差异) 的概率低于50%.
- 发现与更高的MAP目标相关的损害可能性很低.
结论:
- 目前的证据并不强烈支持所有心脏骤停后患者的MAP目标显著更高.
- 较高的MAP目标似乎具有较低的伤害风险.
- 未来的研究应该包括非心脏骤停的原因,并调查更广泛的MAP差异.
相关概念视频
Cardiopulmonary Resuscitation IV: Pharmacological Management
29
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
29
Cardiomyopathy VII: Pre and Post Operative Nursing Management
16
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
16
Cardiopulmonary Resuscitation I: Adult
22
Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
22
Hypertension V: Nursing Management
13
The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
13
Aneurysm IV: Nursing Management
11
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
11
Acute Coronary Syndrome V: Nursing Management
18
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
18


