ukubeka kafushane
UMkhandlu Wokuvuselelwa KwaseYurophu (i-ERC) kanye neNhlangano YaseYurophu Yezemithi Yezokunakekelwa (i-ESICM) ihlanganyele ukuthuthukisa le mihlahlandlela yokunakekela abadala yokuvuselela abantu abadala, ngokuhambisana nesivumelwano samazwe angama-2020 kwi-CPR. Izihloko ezimboziwe zifaka phakathi i-Post-Cardiac Boot Syndrome, Ukutholwa Kwezimbangi Zokuboshwa Kwezinhliziyo, I-Oxygen kanye Nokulawula Ukuvuselisa, Ukulawulwa Kwezinyathelo, Ukulawulwa Kwezingalo, Imiphumela Yesikhathi Eside, Ukuvuselelwa Kwesikhathi Eside, kanye Umnikelo Wezitho.
Amagama agqamile: Ukuboshwa kwenhliziyo, ukunakekelwa kokuvuselela kabusha kwe-postoperative, ukubikezela, imihlahlandlela
Isingeniso nobubanzi
Ngo-2015, uMkhandlu Wokuvuselelwa KwaseYurophu (i-ERC) kanye nomphakathi wase-European Office Medicine (ESICM) esebenzisana nokuthuthukisa imihlahlandlela yokunakekelwa kokuqala ukuqinisekiswa kokuphindaphindwayo, okwakhishwa ekwakhiweni kwemithi yokunakekelwa okubucayi. Le mihlahlandlela yokunakekelwa kwe-post-resusciation yavuselelwa kabanzi ngo-2020 futhi ifakwe kwisayensi eshicilelwe kusukela ngo-2015. Izihloko ezimbozwe zifaka phakathi i-post-cardiac shot syndrome, ukufakwa komoya, ukuphathwa kokushisa okuhlosiwe, ukuphathwa kokushisa okuhlosiwe, ukuphathwa kokulawulwa, ukuqondiswa kabusha, kanye nokuvuselelwa kanye Imiphumela yesikhathi eside (Umdwebo 1).
Isifinyezo sezinguquko ezinkulu
Ukunakekelwa kokuvuselela kabusha ngokushesha:
• Ukwelashwa nge-post-resusciation kuqala ngemuva kwe-ROSC eqhubekayo (ukululama kokusakazwa okuzenzakalelayo), noma ngabe indawo (isithombe 1).
• Ukuboshwa kwenhliziyo ngaphandle kwesibhedlela, cabanga ukuthatha isikhungo sokuboshwa kwenhliziyo. Thola imbangela yokuboshwa kwenhliziyo.
• Uma kunomtholampilo (isib., Ukungazinzi kwe-Hemodynami Uma i-coronary angoography ingakhombisi i-lesion enesibindi, i-CT Evography kanye / noma i-CT pulmonary angiography yenziwa.
• Ukukhonjwa kokuqala kokuphefumula noma ukuphazamiseka kwemizwa kungenziwa ngokwenza ama-CT scans wobuchopho kanye nesifuba ngesikhathi sokulaliswa esibhedlela, ngaphambi noma ngemuva kwe-coronary angiography (bheka i-coronary reperfotion).
• Yenza i-CT yobuchopho kanye / noma i-aviography yamaphaphu uma kunezimpawu noma izimpawu ezibonisa imbangela ye-neurological noma ukuphefumula ngaphambi kwe-asystole (isib. izimo ezaziwayo zokuphefumula).
1. I-Airway nokuphefumula
Ukuphathwa kwe-airway ngemuva kokusakazwa okuzenzakalelayo kubuyiselwe
• Ukusekelwa kwe-airway kanye ne-ventira kumele kuqhubeke ngemuva kokuvuselelwa kokujikeleza okuzenzakalelayo (i-rosc).
• Iziguli eziye zaba nokuboshwa kwenhliziyo, ukubuyela ngokushesha emsebenzini wobuchopho obujwayelekile, futhi ukuphefumula okujwayelekile kungenzeka kungadingi i-endotracheal buttubation, kepha kufanele inikezwe umoya-mpilo nge-mask uma i-arterial oksigen sagrafution ingaphansi kwama-94%.
• I-Endotracheal Intubation kufanele yenziwe ezigulini ezihlale i-comatose ngemuva kwe-rosc, noma iziguli ezinamanye izinkomba zomtholampilo zomoya omncane we-sedation kanye nomoya omncane, uma i-endotracheal infubation ingenziwa ngesikhathi se-CPR.
• I-Endotracheal Intubation kufanele yenziwe ngu-opharetha onolwazi ngesilinganiso sempumelelo ephezulu.
• Ukubekwa kahle kweshubhu endotracheal kumele kuqinisekiswe yi-wavefomform capnography.
• Uma kungekho e-Endotracheal Inubators, kunengqondo ukufaka i-Supraglottic Airway (SGA) noma ulondoloze umgwaqo osebenzisa amasu ayisisekelo kuze kube yilapho i-Inubator enekhono iyatholakala.
Ukulawulwa komoya-mpilo
• Ngemuva kwe-rosc, i-oxygen eyi-100% (noma enkulu) isetshenziswa kuze kube yilapho i-arterien oxygen gcwalisa noma ingcindezi ye-oksijini ingalinganiswa ngokuthembekile.
• Uma nje ukugcwala kwe-oksijini ye-artergen kungalinganiswa noma ivelu yegesi yegazi elisha, i-oxygen ephefumulelwe itholwa ukufeza ukugcwaliseka kwe-oxygen arteright ka-94-98% noma umfutho we-10 kuye ku-13 kuye ku-13 kuye ku-13 kuye ku-13 kuye ku-13 I-KPA noma i-75 kuye ku-100 mmhg (Umdwebo 2).
• 避免 Rosc 后的低氧血症 (Pao2 <8 KPA 或 60 mmhg).
• Gwema i-hyperxemia ngemuva kwe-rosc.
Ukulawula umoya
• Thola amagesi wegazi angenamkhawulo futhi usebenzise ama-End-Tidal CO2 ukuqapha iziguli ezivutha ngomoya.
• Ezigulini ezidinga ukungena umoya omncane ngemuva kwe-ROSC, lungisa umoya omncane ukuze uzuze ingcindezi evamile ye-carbon dioxide (Paco2) ka-4.5 kpa noma ama-35 mmhg.
• I-PACO2 ibhekelelwa kaningi ezigulini eziphathwa ngokuphathwa kokushisa okuhlosiwe (TTM) ngoba i-hypocapnia ingenzeka.
• Amanani wegesi wegazi ahlala alinganiswa kusetshenziswa izindlela zokushisa noma zokungaphansi kokushisa ngesikhathi se-TTM kanye namazinga okushisa aphansi.
• Thola isu lokufaka umoya wamaphaphu lokuthola umoya wokuthola umoya ukuze uzuze umqulu omkhulu we-6 - 8 mL / kg isisindo esifanele somzimba.
2. Ukujikeleza kwe-coronary
ReperFusion
• Iziguli zabantu abadala ezine-rosc zilandela izinsolo zokuboshwa kwenhliziyo kanye nokuphakanyiswa kwe-st-segment ku-eCG kufanele zihlaziswe nge-cartiac catheterization elebhu yelebhu (i-PCI kufanele zenziwe ngokushesha uma kukhonjisiwe).
• Ukuhlolwa kwelebhu yasendlini ephuthumayo kufanele kubhekwe ezigulini ezine-ROSC ebambe ukuboshwa kwe-Cardiac e-Cardiac (OHCA) ngaphandle kwe-St-Segment ukuphakama ku-ECG nokuthi ngubani okulinganiselwa ukuthi anethuba eliphakeme le-artery (isib. Iziguli ze-Haemodynamic kanye / noma zikagesi ezingazinzile).
Ukuqapha kweHaemodynamic kanye nabaphathi
• Ukuqapha okuqhubekayo komfutho wegazi nge-ductus artteriosus kufanele kwenziwe kuzo zonke iziguli, futhi ukuqapha ukubonwa kwenhliziyo kunengqondo ezigulini ze-haemodynamically.
• Yenza i-echocardiogram ekuqaleni (ngokushesha ngangokunokwenzeka) kuzo zonke iziguli ukukhomba noma yiziphi izimo zenhliziyo ezingaphansi futhi zinciphise izinga lokungasebenzi kahle kwe-myocardial.
• Gwema i-hypotension (<65 mmhg). Ithagethi isho ingcindezi ye-arterial (Imephu) ukufezekisa okukhipha umchamo okwanele (> 0.5 ml / kg * h kanye ne-lactate noma encishisiwe (Umdwebo 2).
• IBradyCardia ingashiywa ingalashwa ngesikhathi se-TTM ku-33 ° C Uma umfutho wegazi, i-lactate, i-scvo2, noma i-svo2 yanele. Uma kungenjalo, cabanga ngokwandisa izinga lokushisa eliqondiwe, kepha hhayi eliphakeme kune-36 ° C.
• Ukulungiswa kwesondlo ngoketshezi, i-NorePinephrine, kanye / noma i-dobutamine kuya ngesidingo sevolumu ye-intravascular, i-vasocolstrictions, noma ukuthengiswa kwemisipha esigulini ngasinye.
• Gwema i-hypokolemaa, ehlotshaniswa nama-arrohythmias we-ventricular.
• Uma ukuvuselelwa kwe-fluid, ukuthengiswa kwemisipha, nokwelashwa kwe-vasoactical akwanele, ukusekelwa kokujikeleza kwemishini (isib. I-intre-aortic balloon mpompion, noma i-artericular aversic balbrane okygenation) kungabhekwa ukwelashwa kokushaqeka kwenhliziyo okuphikelelayo ngenxa yesobunxele ukwehluleka kwe-ventricular. Amadivayisi okusiza okusiza kwesobunxele noma i-extracororporceal endovascular oxygenation kufanele futhi abhekwe ezigulini ezine-haemodynamical acate coronary syndrome (ACS) ne-ventricular tachycardia (VF) noma i-fibrillation (VF) noma i-ventricular fibrillation (VF), naphezu kwezinketho zokwelashwa eziphezulu.
3. Umsebenzi we-motor (Ukwandisa ukululama kwe-neurological)
Ukulawulwa kokulawulwa
• Sincoma ukusetshenziswa kwe-electroencephalogram (eeg) ukuthola ama-electroospasms ezigulini ngokuquleka komtholampilo nokubheka impendulo ekwelashweni.
• Ukwelapha ukuqunjelwa ngemuva kokuboshwa kwenhliziyo, siphakamisa i-levetiracetam noma i-sodium valproate njengezidakamizwa zokuqala ze-antiepileptic ngaphezu kwemithi eyosiwe.
• Sincoma ukungasebenzisi izimbambo ezijwayelekile ze-prophylaxis ezigulini ezilandela ukuboshwa kwenhliziyo.
Ukulawulwa kokushisa
• Kubantu abadala abangaphenduli e-OHCA noma e-In-Hospital Cardiac ukuboshwa kwenhliziyo (noma yisiphi isigqi senhliziyo sokuqala), siphakamisa ukuphathwa kwezinga lokushisa okuhlosiwe (TTM).
• Gcina izinga lokushisa eliqondiwe ngenani eliphakathi phakathi kuka-32 no-36 ° C okungenani amahora angama-24.
• Ezigulini ezihlale zi-comatose, gwema umkhuhlane (> 37.7 ° C) okungenani amahora angama-72 ngemuva kwe-rosc.
• Musa ukusebenzisa isixazululo esibandayo se-Adravenous esibandayo ukushisa komzimba okuphansi. Ukuphathwa Kokunakekelwa Okujwayelekile - Ukusetshenziswa kwama-sedatives asebenza amafushane nama-opioids.
• Ukusetshenziswa okujwayelekile kwemithi yokuvinjwa kwe-neuromuscular kugwenywa ezigulini ezine-TTM, kepha kungahle kubhekwe ezimweni zokubabaza kakhulu ngesikhathi se-TTM.
• Ingcindezelo ulcer prophylaxis ihlinzekwa njalo ezigulini ezinokuboshwa kwenhliziyo.
• Ukuvimbela i-thrombosis ejulile ye-vein.
• 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), 避免低血糖 (<4.0 mmol / l (<70 mg / dl).
• Qala okuphakelayo okulinganiselwe okuphansi kwe-Internal (ukondliwa okunempilo) ngesikhathi se-TTM bese kukhuphuka ngemuva kokuphinda kubuye uma kudingeka. Uma i-TTM ye-36 ° C isetshenziswa njengokushisa okuqondiwe, isilinganiso sokudla se-Internal singanda ekuqaleni kwe-TTM.
• Asikukhuthazi ukusetshenziswa okujwayelekile kwe-prophylactic antibiotic.
4. Ukubikezela okujwayelekile
Imihlahlandlela ejwayelekile
• Asincomi ukuncoma ama-prophylactic ama-antibiotic ezigulini ngemuva kokuvuselelwa kabusha ngemuva kokuboshwa kwenhliziyo, i-electrophysiology, ama-biomasker, nobabili ukwazisa imitholampilo kanye nokuthola imizwatha yokwelashwa okusekelwe kwisiguli amathuba okuthola ukululama okunengqondo kwe-neurological (Umdwebo 3).
• Akekho owabikezeli oyedwa onembile. Ngakho-ke, sincoma isu lokubikezela le-multimodal neural.
• Lapho ubikezela imiphumela engemihle yezinzwa, ukucaciswa okuphezulu nokunemba kuyadingeka ukugwema ukubikezela okupheyisi okungamanga.
• Ukuhlolwa kwemitholampilo kwemitholampilo kubalulekile ukuze uthole amandla. Ukugwema ukubikezela okunephutha okunephutha, odokotela kufanele bagweme ukudideka okungaba khona okubangelwa yimiphumela yokuhlola engadideka ngama-sadatives neminye imishanguzo.
• Ukuhlolwa kwemitholampilo kwansuku zonke kugqugquzelwa lapho iziguli ziphathwa nge-TTM, kepha ukuhlolwa kokugcina kwe-prognostic kufanele kwenziwe ngemuva kokuphinda kubuye.
• Odokotela kumele baqaphele ubungozi bokuzibophezela kwesiprofetho okubangelayo ukukhetha, lapho imiphumela yokuhlolwa kwe-Index igcizelela imiphumela empofu ezinqumweni zokwelashwa, ikakhulukazi maqondana nezindlela zokwelapha ezisekela impilo.
• Inhloso yohlolo lwe-NeuroRTOgOs Index test ukuhlola ubukhulu bokulimala kobuchopho kwe-hypoxic-ischemic. I-NeuroRprognos ingenye yezinto ezimbalwa okufanele ucabangele lapho uxoxa ngamathuba womuntu wokululama.
Ukubikezela okulindelekile okuningi
• Qala ukuhlolwa kwe-prognostic ngokuhlolwa okunembile emtholampilo, okwenziwe kuphela ngemuva kwezinto ezinkulu ezididekayo (isib.
• Uma kungekho ebodwa, iziguli ze-comatose ezine-rosc ≥ m≤3 kungakapheli amahora angama-72 kungenzeka ukuthi zibe nemiphumela emibi uma ngabe zibikezelwa ezilandelayo ze-≥ 72 H, ukungabikho kwe-n20 ssep ≥ I-24 h, i-EEG ephezulu> 24 H, Enolase ethize ye-Neuronal (NSE)> I-60 μg / l ngo-48 h, izwe i-MYoclonus ≤ 72 h, noma ukulimala kwe-Hypoxic. Iningi lalezi zimpawu lingaqoshwa ngaphambi kuka-72 h we-rosc; Kodwa-ke, imiphumela yabo izohlolwa kuphela ngesikhathi sokuhlola kwe-desxolostic.
Ukuhlolwa Kwemitholampilo
• Ukuhlolwa kwemitholampilo kutholakala ekuphazanyisweni kwama-sedatives, ama-opioids, noma ama-musiclants reland. Ukudideka okungenzeka okudidekayo okuseleyo kufanele kubhekwe ngaso sonke isikhathi futhi kukhishwe.
• Ezigulini ezihlala emahoreni ama-coma 72 noma kamuva ngemuva kwe-rosc, izivivinyo ezilandelayo zingabikezela i-prognosistos emibi kakhulu.
• Ezigulini ezihlala zihlale amahora angama-72 noma kamuva ngemuva kwe-rosc, izivivinyo ezilandelayo zingabikezela imiphumela emibi ye-neurological:
- Ukungabikho kwe-BILATERS ejwayelekile yokukhanya kwesibane
- Ubufundi obuningi
- Ukulahleka kwe-corneal reflex ezinhlangothini zombili
- I-MyOClonus kungakapheli amahora angama-96, ikakhulukazi i-Myoclonus yezwe kungakapheli amahora angama-72
Siphinde sincome ukuqopha i-EEG eBukhoneni be-MyOClonic Tics ukuze bathole noma yimuphi umsebenzi ohlobene nokuhlongoza noma ukukhomba izimpawu ze-EEG, njengokuqhubeka kwangemuva, okuphakamisa amandla okuvuselela ama-neurological.
neurophysiology
• I-EEG (Electroencephalogram) yenziwa ezigulini ezilahlekelwa ukuqaphela ngemuva kokuboshwa kwenhliziyo.
• Amaphethini we-EEG amaningi kakhulu afaka izizinda zokuvimbela ezivinjelwe noma ngaphandle kwama-diskarges ngezikhathi ezithile kanye nokuqhuma kokuqhuma. Sincoma ukusebenzisa lezi zingamaphethini we-EEG njengesikhombi sokuqanjwa kabi ngemuva kokuphela kwe-TTM nangemva kokudilizwa.
• Ukuba khona kokuhlaselwa okuqondile ku-EEG emahoreni okuqala angama-72 ngemuva kokuthi i-Rosc iyinkomba yokuqanjwa kabi.
• Ukuntuleka kwempendulo yangemuva ku-EEG kuyinkomba yokuhlolisisa kabi ngemuva kokuboshwa kwenhliziyo.
• Ukulahleka kwe-Cartical Somatosensory-okubangelwa yi-Onical N20 kuyinkomba ye-prognosis empofu ngemuva kokuboshwa kwenhliziyo.
• Imiphumela ye-EEG neSomtosensory evusa amandla (i-SSEP) imvamisa icatshangelwa kumongo wokuhlolwa kwemitholampilo nezinye izivivinyo. Izidakamizwa zokuvimba ze-Neuromuscular kumele zibhekwe lapho kwenziwa i-SSEP.
Ama-biomarkers
• Sebenzisa uhla lwezilinganiso ze-NSE ngokuhlanganiswa nezinye izindlela ukubikezela imiphumela ngemuva kokuboshwa kwenhliziyo. Amanani aphakeme ngamahora angama-24 kuye kwangama-48 noma amahora angama-72, ahlanganiswe namanani aphezulu ngamahora angama-48 kuye kwangama-72, abonise i-prognosis engeyinhle.
Into eminga
• Sebenzisa izifundo zokucabanga kobuchopho ukubikezela imiphumela engemihle ye-neurological ngemuva kokuboshwa kwenhliziyo ngokuhlanganiswa nabanye ababikezeli ezikhundleni ezifanelekile zocwaningo.
• Ukuba khona kwe-cerebral ederal edema evamile, kuboniswe ukwehliswa okumakiwe ku-Grey / White The Matter ratio ku-CT CT, noma ukukhawulelwa kokuphazamiseka okuphelele ku-Brain MRI, kubikezela ukuqondiswa kobuchopho kwe-MRI, kubikezela ukubhekelwa phansi kwengqondo ngemuva kokuboshwa kwenhliziyo.
• Ukutholwa kokucabanga kuvame ukubhekwa ngokuhlanganiswa nezinye izindlela ukubikezela i-neurological prognosis.
5. Misa ukwelashwa okusekela impilo
• Ingxoxo ehlukile yokuhlolwa kwe-prognosis kokuvuselelwa kwe-neurorogical kokulashwa okusekela impilo (i-WLST); Isinqumo sokuthi i-WLST kufanele icabangele izici ngaphandle kokulimala kobuchopho, njengeminyaka, i-comorbidity, umsebenzi wesitho se-system, nokukhethwa kwesiguli, nokukhethwa kwesiguli.
Ukwaba isikhathi esanele sokuxhumana, ukuqondiswa kwesikhathi eside ngemuva kokuboshwa kwenhliziyo
Izinga lokwelashwa ngaphakathi kweqembu linquma futhi • luqhubekele ekuhlolweni kokusebenza ngokomzimba nangelona okuhlobene nezihlobo. Ukutholwa kusenesikhathi kwezidingo zokuvuselelwa kokulimazeka ngokomzimba ngaphambi kokukhipha nokunikezwa kwezinsizakalo zokuvuselela lapho kudingeka. (Umdwebo 5).
• Hlela ukuvakasha okulandelayo kwabo bonke abasinda be-Cardiac abasinde ngaphakathi kwezinyanga ezi-3 zokukhululwa, kufaka phakathi okulandelayo:
- 1. Isikrini izinkinga zokuqonda.
2. Isikrini izinkinga zemizwa nokukhathala.
3. Nikeza imininingwane nokusekelwa kwabasindile kanye nemindeni.
6. Ukunikela ngesitho
• Zonke izinqumo eziphathelene nokunikelwa kwesitho kumele zihambisane nezidingo zezomthetho zendawo nezokuziphatha.
• Ukunikela ngesitho kufanele kubhekwe kulabo abahlangana ne-ROSC futhi bahlangabezane nenqubo yokufa kwe-neurological (Umdwebo 6).
• Ezigulini ezivutha umoya ezinama-comatologing ezingahlangabezani nezindlela zokufa kwemizwa, ukunikela ngomnikelo wesitho kufanele kubhekwe ngesikhathi sokuboshwa kokujikeleza uma kwenziwa isinqumo sokuqala ukwelashwa kokuphela kanye nokuyeka ukusekelwa kwempilo.
Isikhathi Sokuposa: Jul-26-2024