Pfupiso
Iyo European Ressignation Council (EEPER) uye European Society yeCrostical Confelly Comel (ESICM) yakawedzera kukudziridza nhungamiro dzeVakuru, zvinoenderana neye 2020 kubvumirana kweSainzi uye kurapwa kweCPR. Misoro yakafukidzwa inosanganisira Post-CarsiaC Arrest syndrome, Kuongororwa Kwemakona, Kubata Kwekudzivirira organti organsi.
Keywords: Cartia Kusungwa, Postopative Kudzokorora Kutarisirwa, kufungidzira, nhungamiro
Nhanganyaya uye Scope
Muna 2015, kanzuru yeEurope yeEurope. Iyi post-yekudzokorora kutarisirwa nhungamiro yakawedzerwa muna 2020 uye kusanganisa Sayenzi Yakatemwa Long-Term Zvitsauko (Mufananidzo 1).
Pfupiso yekuchinja kukuru
Pakarepo Post-Regency Kuchengeta:
• Kurapa kwekutumira kwekutangazve kunotanga nekukurumidza mushure mekusimbisa rosc (kudzoreredzwa kwekutenderera kwekunze), zvisinei nenzvimbo (nhamba 1).
• Zvekunze-kwechipatara Carsiac Kusungwa, funga kutora kadhi remwoyo Arrest nzvimbo. Kuongorora chikonzero chekusungwa kwemari.
• Kana paine kiriniki (semuenzaniso, hemodynamic kusagadzikana) kana ecg ufakazi hweMyancardial Ischemia, Coronary angiography inotanga kuitwa kutanga. Kana Coronary angiography isingazive iyo caussion lesion, ct encepography uye / kana ct pulmonary angiography inoitwa.
• Kuzivikanwa kwekutanga kwekufema
• Ita ct yehuropi uye / kana angiography yemapapu kana paine zviratidzo kana zviratidzo zvinongedzo zvekupfidza zvisati zvaitika (eg mamiriro anozivikanwa ekufema).
1. Airway uye kufema
Manejimendi manejimendi mushure mekupora kutenderera kwakadzoreredzwa
• Airway uye Ventiratory rutsigiro runofanira kuenderera mberi mushure mekupora kwekupora kutenderera (rosc).
• Varwere vane tonic tonic kusungwa, nekukasira kudzoka kune zvakajairika brain basa, asi vanofanira kufema zvingangoda kuhukura, kana okisigen kuburikidza neyekusimbisa kweOxygen kana kuwanda kweOxygen isingasviki 94%.
• Endotracheal Intubation inofanira kuitwa muvarwere vanoramba vachiramba mushure me rosc, kana varwere vane zvimwe zvechirungu, kana endotracheal intation
• Endotracheal Intubation inofanira kuitwa neanosangana neanosangana neyekubudirira kwebudiriro.
• Kugadziriswa kwakakodzera kweiyo endotracheal tube inofanirwa kusimbiswa neyekuwedzera ruzivo rwekuwedzera.
• Mukushaikwa kweshoko renzvimbo dzekupedzisira
Controg Control
• Mushure mekunge rosc, 100% (kana mawedzera anowanikwa) okisijeni inoshandiswa kusvikira arterial emagetsi oksijeni kana gadziriso yekumanikidza inogona kuyerwa.
• Kamwe chete gadziriso yekugadzira okisijeni inogona kuvimbika KPA kana 75 kusvika 100 mmhg (Mufananidzo 2).
• 避免 rosc 后的低氧血症 (Pao2 <8 kpa × 60 mmhg).
• Dzivisa hyperxemia mushure me rosc.
Ventilation Control
• Tsvaga gadziriso yeropa yeropa uye shandisa yekupedzisira
• Kune varwere vanoda kuti michina yemhepo mushure mekunge rosc
• Paco2 inowanzotariswa muvarwere vakabatwa neanonongedzerwa tembiricha manejimendi (TTM) nekuti hypocapnia inogona kuitika.
• Ropa regesi gasi rinogara kuyerwa uchishandisa tembiricha kana isiri-tembiricha nzira panguva yeTTM uye yakaderera tembiricha.
• Tinotora mapapu-ekudzivirira mhepo yekuvira
2. Coronary kutenderera
Kuparadzwa
• Varwere vakuru vane rosc vachitevera kufungidzira kwekusungwa kwemari uye st-chikamu chekukwirira kuECG vanofanirwa kuitwa neCatendeization Catendezation (PCI inofanira kuitwa pakarepo kana ichiratidzwa).
• Inokurumidzira Catheration Catendezation Kuongororwa kunofanirwa kutariswa muRosc Vakasungwa ECG uye vanofungidzirwa kuti vane mukana weiyo action arterlusion (semuenzaniso, haenzidynamic uye / kana magetsi asina kugadzikana varwere).
Haenzidynamic yekutarisa uye manejimendi
• Kuenderera mberi kwekutarisa kweropa kuburikidza neDuctus Arteriosus kunofanirwa kuitwa muvarwere vese, uye Carchic Output kutarisa zvine musoro mumarwere asina kugadzikana asina kugadzikana.
• Ita echocardiograms nekutanga (nekukurumidza sezvinobvira) mune vese varwere kuti vaone chero mamiriro ezvinhu echiratidzo uye kuti udzikise mwero weDysfunction.
• Dzivisa hypotension (<65 mmhg). Target zvinoreva kuratidzira kumanikidzwa (mepu) kuti uwane zvakakwana Urine kubuda (> 0.5 ml / kg * h uye yakajairwa kana yakaderedzwa lactate (Mufananidzo 2).
• Bradycarsia inogona kusiiwa isina kurapwa panguva yeTM pa3 33 c ° C kana yeropa, lactate, sklo2, kana svo2 yakazara zvakakwana. Kana zvisiri, funga kuwedzera tembiricha yeku tembiricha, asi isina kukwirira kupfuura makumi matatu neshanu c.
• Kugadziriswa kwekunyepedzera nemvura, norepinephrine, uye / kana dobutamine zvichienderana nekudikanwa kweiyo intravascular vhoriyamu, Vasoconstriction, kana tsandanyama yemurwere.
• Dzivisa hypokalemia, iyo inosanganiswa neVentricular Arrhythmias.
• Kana kudzokorodza kwemvura, kupokana kwemasumbu, uye kusarudzika kwekurapa kwakakwana ventricular kukundikana. Kuruboshwe ventricular inobatsira zvishandiso kana exthocorporeal ooxgenculy inofanirwawo kutariswa mune dzevarwere neKornary TachyCalcia (vF) kana ventricular fibrilation (VF)
3. Motor basa (Optimize neurology kupora)
Kudzora Kubata
• Tinokurudzira kushandiswa kweElectroencephalograph (eeg) kuongorora magetsi mumagetsi mune varwere vane chirwere chekiriniki uye kutarisa mhinduro yekurapwa.
• Kurapa kusungwa mushure mekusungwa kwemwoyo, tinokurudzira kuti Levetiracetam kana sodium axproet seyekutanga-mutsara antiepilepic zvinodhaka mukuwedzera kumishonga yekunyepedzera.
• Isu tinokurudzira kusashandisa nzira yekubatwa prophylaxis muvarwere vachitevera kusungwa kwemwoyo.
Kudzora tembiricha
• Kune vakuru vasingapinduri kuOhca kana mu-chipatara chiratidziro chiratiswa
• Chengetedza tembiricha yeku tembiricha pane inogara ichikosha pakati pamakumi matatu nemakumi matatu nemakumi matatu emakore kusvika maawa makumi maviri nemana.
• Kune varwere vanoramba vakamanikidza, dzivisa fever (> 37.7 ° C) kweanokwana maawa makumi manomwe neshanu mushure me rosc.
• Usashandise prehlpar pospart intravenous Cold Solution yekudzikisira tembiricha yemuviri. General Intensive Care Management - Kushandiswa Kwepfupi-Kuita Kununurwa uye opioids.
• Kushandiswa kwemaitiro euromuscular kuvhara zvinodhaka zvinodzivirirwa murevarwere neTTM, asi zvinogona kutariswa mumamiriro ezvinhu ekukwira zvakanyanya panguva yeTTM.
• Kushungurudza ulcer prophylaxis inogara ichirwiswa kune varwere vane musungwa.
• Kudzivirira kwepamusoro vein thrombosis.
• 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).
• Kutanga low-red inonyora chikafu (chikafu chehutano) panguva yeTTM uye kuwedzera mushure mekudzoreredzwa kana zvichidikanwa. Kana ttm ya6 ° C ichishandiswa seyevanzika tembiricha, iyo inopinda yekudyisa yekudya inogona kuwedzera pakutanga panguva yeTTM.
• Hatikurudzire maitiro ekushandisa kweProphylactic Anstautics.
4. Kufungidzira kwechiitiko
General Nhungamiro
• Isu hatikurudzire priphylactic mishonga yevarwere vasingazive mushure mekusungwa kwekiriniki, uye neuropelogy, uye kufungidzira kuti kuzivisa varwere vanoronga kurapwa kwakavakirwa pamwoyo mikana yekuzadzisa kukosha kweutsinye kupora (Mufananidzo 3).
• Hapana mumwe anofanotaura ari 100% chaiyo. Naizvozvo, isu tinokurudzira iyo mulimizwi aneural anelattion zano.
• Paunenge uchifanidza zvabuda zvisina mwero zvehunhu, zvakakwirira zvakanyanyisa uye kurongeka zvinodikanwa kuti udzivise kufembera kwekunyepa kwekunyepa.
• Clinical neurologation bvunzo yakakosha kuti uwane proong. Kuti udzivise kufungidzira kusingatarisirwi, vanorembenha havafanirwe kudzivisa kunyadziswa kwemhedzisiro yemipiro inokwanisa kuvhiringidzwa nekupindirana uye mimwe mishonga.
• Kuongororwa kwezuva nezuva kwekuongororwa kana varwere vachibatwa neTTM, asi yekupedzisira prognostic idzisiro inofanirwa kuitwa mushure mekudzoreredzwa.
• Vanorembera vanofanira kuziva nezve njodzi yekuzvishingisa zviporofita zvekuzvipira, izvo zvinoitika kana index bvunzo mhinduro dzinofanotaura zvisarudzo zvekurapa, kunyanya nezve marapirwo ekurapa.
• Chinangwa cheiyo neuroprophnosiss index bvunzo ndeyekuongorora kuomarara kweiyo hypoxic-ischemic proin kukuvara kwehuropi. NeuropropHosis ndeimwe yezvikamu zvakati kuti fungidzire paunenge uchikurukura mukana wekupora.
Multi-Model Kufungidzira
• Kutanga bvunzo dzekiriniki dzakarongeka, dzakaitwa chete mushure mezvinhu zvakakura zvinonyadzisa (semuenzaniso, kusara kwesangano, hypothermia) zvakadzimwa (Mufananidzo 4)
• Mukushayikwa kweVanyori, vatengesi vechirungu 24 H, High-Giredhi Eeg> 24 H, NZIRA NEURONIL ENLAE (NSE)> 60 μ Zvizhinji zvezviratidzo izvi zvinogona kunyorwa pamberi pe72 h ye rosc; Nekudaro, mhedzisiro yavo ichangoongororwa panguva yekuongororwa kwekiriniki.
Kiriniki bvunzo
• Kuongororwa kwekiriniki kunokanganiswa nekupindira kubva kununuroveswa, opioids, kana tsandanyama dzinotonhora. Zvinogoneka kuvhiringidza nekuseri kwesangano kunofanirwa kufungwa nezvazvo uye kutongwa kunze.
• Kune varwere vanoramba vari mumakore manomwe emakumi mapfumbamwe kana gare gare mushure meRosc, iyo inotevera bvunzo dzinogona kufanotaura nezverognos
• Mune varwere vanoramba vachitenda kwemaawa makumi manomwe nematanhatu kana gare gare mushure mekunge rosc, bvunzo dzinotevera dzinogona kufanotaura zvabuda mumatsotsi:
- kusavapo kwe bilateral yakajairwa pupillary mwenje rezvinyorwa
- Quantitative Pupilometry
- kurasikirwa kweCorneal Reflex pamativi ese maviri
- Myoclonus mukati memaawa makumi mapfumbamwe nemashanu, kunyanya kuHurumende myoclonus mukati memaawa makumi manomwe nemasere
Isu tinokurudzira zvakare kurekodha eeg pamberi peMyOcLlonic tics kuitira kuti vaone chero chakabatana nepile pabasa kana kuratidza mhinduro yeEEG, yakadai sekupindura kwemashure kana kuenderera mberi, kupa mukana wekupora kwemutsipa.
neurichysology
• EEG (Electroventownphalogram) inoitwa muvarwere vanorasikirwa nekuziva mushure mekusungwa kwemwoyo.
• Akashata eeg maitiro eEEG anosanganisira kudzvinyirira kumashure kana pasina nguva yekubvisa uye kuputika kudzvinyirira. Isu tinokurudzira kushandisa aya eeg mapatani sechiratidzo chekusanzwisisika proong mushure mekupera kweTTM uye mushure mekusangana.
• Kuvapo kwechokwadi kwakabatanidzwa paEEG mumaawa ekutanga makumi manomwe nemasere mushure mekutanga rosc chiratidzo chezvakaipa proong.
• Kushaikwa kwemhinduro yemashure paEEG chiratidzo chebarire rekusungwa mushure mekusungwa kwemwoyo mushure mekusungwa kwemwoyo.
• Bilateral Somatosensory-yakakundwa kurasikirwa kwekoramu yeCortical N00 inogona chiratidzo chekusungwa kwemuto mushure mekusungwa kwemwoyo mushure mekusungwa kwemwoyo
• Migumisiro yeEEG uye Somatosensory yakamutsa njodzi (ssep) inowanzoonekwa mune mamiriro ekuongororwa kwekiriniki uye dzimwe bvunzo. Neuromuscular kuvhara zvinodhaka zvinofanirwa kutariswa kana ssep yaitwa.
Biomarkers
• Shandisa huwandu hwezviyero zveNSE musanganiswa nedzimwe nzira kufanotaura nezviratidzo mushure mekusungwa kwemwoyo. Akakwidziridzwa tsika kuma2 makumi maviri nemana kusvika maawa makumi mana nemasere kana maawa makumi manomwe nemaviri, akasanganiswa nehuwandu hwakanyanya panguva 48 kusvika pamakumi manomwe neshanu, ratidza kusarongeka.
Kufungidzira
• Shandisa pfungwa dzekufungidzira dzinofungidzira kuti kufanotaura nezvematambudziko emuchina mushure mekusungwa kwemwoyo mushure mekusanganiswa nevamwe vanofanotaura mumasangano ane ruzivo rwakakodzera.
• Kuvapo kweiyo generalized cereda
• Kufungidzira zvakawanikwa kunowanzoonekwa mukubatanidzwa nedzimwe nzira kufanotaura neurodhiyo proong.
5. Misa hupenyu-hwekutsigira kurapwa
• Kukurukurirana kwekutsaurwa kwekuongororwa kwechiitiko chekubviswa uye kudzoreredzwa kwekurapa kwekurapa kwehupenyu (WLST); Chisarudzo chekuti wlst anofanira kuenderana nezvimwe zvinhu kunze kwekukuvara kwehuropi, senge zera, comorbidity, systemic nhengo yebasa, uye kusarudzwa kwemurwere.
Govera nguva yakakwana yekutaurirana, refu-term proft mushure mekusungwa kwemwoyo
Chikamu chekurapa mukati mechikwata chinosarudza uye Kubvira kwekutanga kwekuvandudza zvido zvekukanganisika kwemuviri usati wadhindwa uye kupiwa kwemasevhisi ekugadzirisa pazvinodiwa. (Mufananidzo 5).
• Kuronga kutevera kushanya kwevakaponeswa vese vechiremba vapukunyuki vari mukati memwedzi mitatu yekubuda, kusanganisira zvinotevera:
- 1. Screen yezvinetso zvekuziva.
2. Screen yezvinetso zvemood uye kupera simba.
3. Ipa ruzivo uye rutsigiro kune vanopukunyuka nemhuri.
6. Or Or Or Or Ort
• Zvese zvisarudzo zvine chekuita nezve mupiro wechigwe unofanirwa kutevedzera zvemunharaunda uye zvine tsika.
• Mipiro yemienzaniso inofanirwa kutariswa kune avo vanosangana nerosc uye vanosangana nemaitiro ekufa kwehupenyu (Mufananidzo 6).
• Munzvimbo dzakakomberedzwa dzevarwere vasina kusangana nemaitiro ekufa, mupiro wechirume unofanirwa kufungwa nezvenguva yekuchengetedzwa kana sarudzo ichiitwa kutanga-kwehupenyu hwekurapa uye kurega rutsigiro rwehupenyu.
Kutumira Nguva: Jul-26-2024