在复苏后进行管理
Wilhelm Behringer1, Markus B Skrifvars2, Fabio Silvio Taccone3
1Department of Emergency Medicine, Medical University of Vienna, Austria.
Current opinion in critical care
|November 1, 2023
概括
最佳的心脏骤停后的护理侧重于通风,血液循环和温度控制. 目前的证据表明,避免低氧目标,并强调多模式神经预后,以获得更好的患者结果.
科学领域:
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
- 神经学 神经学
背景情况:
- 心脏骤停后成功的复苏需要仔细的复苏后护理.
- 基于证据的指导方针不断发展,需要定期更新最佳管理策略.
研究的目的:
- 审查关于心脏骤停后护理的最新科学证据.
- 涵盖通风/氧化,血液循环,温度控制,一般重症监护和神经预后.
主要方法:
- 审查最近的科学证据和随机临床试验的元分析.
- 对观察性研究和当前指导方针的分析.
主要成果:
- 较低的氧气目标 (90-94%) 与不良结果有关;轻微的头皮增大没有显示好处.
- 对于较高的平均动脉压目标 (>65 mmHg) 或激进的液体/异位使用,没有明显的优势.
- 低温 (32-34°C) 的疗效仍有争议;诺拉丁上腺素是首选的血管压缩剂.
- 神经肌肉阻塞可能会改善结果,而预防性抗生素没有.
- 神经学预后需要采用多模式的方法;多种预测因素表明结果不佳.
结论:
- 复苏后的护理应针对正常血,正常头和正常血压.
- 最佳的温度管理 (32-34°C与预防发烧) 需要进一步澄清.
- 多模式评估对于在心脏骤停后准确的神经预后至关重要.
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