nchịkọta
European Resuscitation Council (ERC) na European Society of Critical Care Medicine (ESICM) ejikọtala ọnụ iji zụlite ụkpụrụ nlekọta nlekọta ndị a na-emeghachi azụ maka ndị okenye, n'ikwekọ na 2020 International Consensus on Science and Treatment of CPR. Isiokwu ndị ekpuchiri gụnyere ọrịa njide obi na-esochi, nchọpụta nke ihe kpatara njide obi, oxygen na ventilashion, infusion coronary, hemodynamic monitoring and management, njide njide, njikwa okpomọkụ, nlekọta ahụike zuru oke, prognosis, nsonaazụ ogologo oge, nhazigharị, na inye akụkụ ahụ.
Keywords: Njide obi obi, nlekọta mkpali na-esote, amụma, ntuziaka
Okwu mmalite na oke
Na 2015, European Resuscitation Council (ERC) na European Society of Critical Care Medicine (ESICM) jikọrọ aka na-emepụta ụkpụrụ nlekọta nlekọta ahụike nke mbụ na-emeghachi azụ, bụ nke e bipụtara na Resuscitation and Critical Care Medicine. A na-emelite ụkpụrụ nlekọta nlekọta ndị a na-emeghachi azụ azụ na 2020 ma tinye sayensị na-ebipụta kemgbe 2015. Isiokwu ndị a na-ekpuchi gụnyere ọrịa njide obi nke post-cardiac, oxygen na ventilation control, hemodynamic targets, infusion infusion, okpomọkụ ezubere iche, njikwa njide, prognosis, rehabilitation, na nsonaazụ ogologo oge (Fig 1).
Nchịkọta nke nnukwu mgbanwe
Nlekọta mkpaliteghachi ozugbo:
• Ọgwụgwọ nlọghachi azụ na-amalite ozugbo ROSC kwadoro (nweghachi nke mgbasa ozi ozugbo), n'agbanyeghị ọnọdụ (Nyocha 1).
• Maka njide obi na-apụ apụ n'ụlọ ọgwụ, tụlee iburu ebe a na-ejide obi obi. Chọpụta ihe kpatara njide obi.
• Ọ bụrụ na enwere ụlọ ọgwụ (dịka ọmụmaatụ, enweghị ike hemodynamic) ma ọ bụ ihe akaebe ECG nke ischemia myocardial, a na-ebu ụzọ mee angiography akwara obi. Ọ bụrụ na angiography nke akwara ọbara achọpụtaghị ọnya na-akpata, a na-eme CT enpography na / ma ọ bụ CT pulmonary angiography.
• Enwere ike ime nchọpụta mmalite nke nsogbu iku ume ma ọ bụ akwara ozi site na ịme nyocha CT nke ụbụrụ na obi mgbe a na-aga ụlọ ọgwụ, tupu ma ọ bụ mgbe e mesịrị angiography nke akwara obi (lee Coronary Reperfusion).
Mee CT nke ụbụrụ na/ma ọ bụ angiography nke ngụgụ ma ọ bụrụ na e nwere ihe ịrịba ama ma ọ bụ ihe mgbaàmà na-egosi ihe na-akpata akwara ozi ma ọ bụ iku ume tupu asystole (dịka, isi ọwụwa, epilepsy, ma ọ bụ ụkọ akwara ozi, mkpụmkpụ ume, ma ọ bụ hypoxemia edepụtara na ndị ọrịa nwere ọrịa ahụ). ọnọdụ iku ume mara).
1. Ụgbọ elu na iku ume
Nlekọta ụgbọ elu ka eweghachiri mgbasa ozi na mberede
• Ekwesịrị ịga n'ihu na nkwado ikuku na ikuku ikuku mgbe mgbake nke mgbasa ozi ozugbo (ROSC).
• Ndị ọrịa nwere njide obi na-adịru nwa oge, ịlaghachi ozugbo na ọrụ ụbụrụ nkịtị, na iku ume nkịtị nwere ike ọ gaghị achọ intubation endotracheal, mana ekwesịrị inye oxygen site na nkpuchi ma ọ bụrụ na ikuku oxygen saturation ha na-erughị 94%.
• Edotracheal intubation kwesịrị ime na ndị ọrịa na-anọgide na-comatose mgbe ROSC, ma ọ bụ maka ndị ọrịa nwere ihe ngosi ụlọ ọgwụ ndị ọzọ maka nkwụsịtụ na ikuku ventilashị, ma ọ bụrụ na a naghị eme endotracheal intubation n'oge CPR.
• Intubation endotracheal kwesịrị ịrụ ọrụ site n'aka onye ọrụ nwere ahụmahụ nwere oke ọganiihu.
• A ga-akwadorịrị ntinye nke ọma nke tube endotracheal site na capnography nke waveform.
• Na enweghị ahụmahụ endotracheal intubators, ọ bụ ihe ezi uche dị na ya ịtinye ụzọ ụgbọ elu supraglottic (SGA) ma ọ bụ na-eji usoro ndị bụ isi na-eme njem ruo mgbe enwere ọkachamara intubator.
Oxygen akara
• Mgbe ROSC gachara, a na-eji 100% (ma ọ bụ karịa) ikuku oxygen ruo mgbe enwere ike tụọ nrịbama ikuku oxygen na akwara akwara ma ọ bụ akụkụ akụkụ nke ikuku oxygen.
• Ozugbo enwere ike tụọ saturation oxygen nke akwara akwara ma ọ bụ nweta uru gas dị n'ọbara akwara, a na-edobe oxygen sitere n'ike mmụọ nsọ iji nweta saturation oxygen arterial nke 94-98% ma ọ bụ nrụgide akụkụ akụkụ nke oxygen (PaO2) nke 10 ruo 13. kPa ma ọ bụ 75 ruo 100 mmHg (Foto 2).
• 避免ROSC后的低氧血症(PaO2 <8 kPa或60 mmHg).
• Zere hyperxemia mgbe ROSC gachara.
Njikwa ikuku
• Nweta gas ọbara akwara ma jiri njedebe njedebe CO2 nyochaa n'ime ndị ọrịa nwere ikuku ikuku.
• Maka ndị ọrịa na-achọ ikuku ventilashị mgbe ROSC gasịrị, gbanwee ventilashion iji nweta nrụgide akụkụ akụkụ nke ikuku carbon dioxide (PaCO2) nke 4.5 ruo 6.0 kPa ma ọ bụ 35 ruo 45 mmHg.
• A na-enyocha PaCO2 ugboro ugboro na ndị ọrịa na-emeso ya na nlekọta okpomọkụ ezubere iche (TTM) n'ihi na hypocapnia nwere ike ime.
• A na-atụ ọnụ ahịa gas ọbara mgbe niile site na iji ọnọdụ mgbanwe okpomọkụ ma ọ bụ na-abụghị okpomọkụ n'oge TTM na obere okpomọkụ.
• Nabata usoro nchekwa ikuku ikuku iji nweta oke mmiri nke 6 – 8 ml/kg nke oke ahụ dị mma.
2. Mgbasa akwara
Ntugharị
• Ndị ọrịa toro eto nwere ROSC na-esochi enyo nke njide obi na ST-ngalaba elu na ECG kwesịrị ịga nyocha ụlọ nyocha ngwa ngwa nke obi catheterization (PCI ga-eme ozugbo ma ọ bụrụ na egosipụtara).
• Ekwesịrị ịtụle nyocha ụlọ nyocha nke obi ngwa ngwa na ndị ọrịa nwere ROSC bụ ndị nwere njide obi na-apụ apụ n'ụlọ ọgwụ (OHCA) na-enweghị mbuli elu ST-ngalaba na ECG na ndị a na-eche na ha nwere ohere dị elu nke nnukwu oghere akwara obi (dịka ọmụmaatụ. hemodynamic na / ma ọ bụ ndị ọrịa na-akwụghị ụgwọ eletrik).
Haemodynamic nlekota na njikwa
• Nleba anya na-aga n'ihu nke ọbara mgbali elu site na ductus arteriosus kwesịrị ka a na-eme ya na ndị ọrịa niile, na nlekota mmepụta obi obi bụ ihe ezi uche dị na ya na ndị ọrịa hemodynamic na-adịghị akwụ ụgwọ.
• Mee echocardiogram n'oge (ozugbo enwere ike) n'ime ndị ọrịa niile iji chọpụta ọnọdụ obi obi ọ bụla na-akpata yana ịkọwa ogo nke arụrụ ọrụ myocardial.
• Zere hypotension (< 65 mmHg). Ebumnuche pụtara nrụgide akwara (MAP) iji nweta mmepụta mmamịrị zuru oke (> 0.5 mL / kg * h na lactate nkịtị ma ọ bụ belata (Njirimara 2).
• Enwere ike ịhapụ Bradycardia n'oge TTM na 33 Celsius ma ọ bụrụ na ọbara mgbali elu, lactate, ScvO2, ma ọ bụ SvO2 zuru oke. Ọ bụrụ na ọ bụghị, tụlee ịbawanye ọnọdụ okpomọkụ, ma ọ bụghị elu karịa 36 Celsius.
• Ịkwado perfusion na mmiri mmiri, norepinephrine, na / ma ọ bụ dobutamine dabere na mkpa nke intravascular olu, vasoconstriction, ma ọ bụ muscle mkpirisi na onye ọrịa.
• Zere hypokalemia, nke jikọtara ya na ventricular arrhythmias.
• Ọ bụrụ na mweghachi nke mmiri mmiri, mkpụkọ akwara, na ọgwụgwọ vasoactive ezughị oke, nkwado nke sistemu ọbara ọgbụgba (dịka ọmụmaatụ, intra-aortic balloon pump, left ventricular help device, or arteriovenous extracorporeal membrane oxygenation) enwere ike ịtụle maka ọgwụgwọ nke ujo cardiogenic na-adịgide adịgide n'ihi aka ekpe. ọdịda ventricular. Ekwesịrị ịtụle ngwaọrụ enyemaka aka ekpe ma ọ bụ oxygenation extracorporeal endovascular na ndị ọrịa nwere hemodynamically unstable acute coronary syndrome (ACS) na recurrent ventricular tachycardia (VT) ma ọ bụ ventricular fibrillation (VF), n'agbanyeghị nhọrọ ọgwụgwọ kachasị mma.
3. Ọrụ moto (na-ebuli mgbake akwara ozi)
Njikwa ọdịdọ
• Anyị na-akwado ka e jiri electroencephalogram (EEG) chọpụta electrospasms na ndị ọrịa nwere nhụsianya ụlọ ọgwụ na iji nyochaa nzaghachi na ọgwụgwọ.
• Iji na-emeso ọdịdọ mgbe e jidere obi, anyị na-atụ aro levetiracetam ma ọ bụ sodium valproate dị ka ọgwụ mgbochi mbụ na mgbakwunye na ọgwụ ndị na-edozi ahụ.
• Anyị na-akwado ka ị ghara iji prophylaxis ọdịdọ mgbe niile na ndị ọrịa na-esochi obi obi.
Njikwa okpomọkụ
• Maka ndị okenye na-anabataghị OHCA ma ọ bụ njide obi obi n'ụlọ ọgwụ (mkpụrụ obi mbụ ọ bụla), anyị na-atụ aro njikwa okpomọkụ ezubere iche (TTM).
• Debe okpomọkụ ebumnuche na uru mgbe niile n'etiti 32 na 36 Celsius C ma ọ dịkarịa ala awa 24.
• Maka ndị ọrịa na-anọgide na-adịghị ike, zere ahụ ọkụ (> 37.7°C) ma ọ dịkarịa ala awa 72 ka ROSC gachara.
• Ejila ihe ngwọta oyi na-atụ tupu ụlọọgwụ iji wedata okpomọkụ ahụ. Nlekọta nlekọta ahụike zuru oke - Iji ọgwụ na-eme mkpụmkpụ na opioids.
• A na-ezere iji ọgwụ mgbochi neuromuscular eme ihe mgbe niile n'ime ndị ọrịa nwere TTM, mana enwere ike ịtụle ya n'ọnọdụ oke oyi n'oge TTM.
• A na-enye prophylaxis ọnya mgbakasị ahụ mgbe niile nye ndị ọrịa nwere obi ejidere.
• Mgbochi nke thrombosis miri emi.
• 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（7.0mm mg/dL).
• Malite ndepụta ntinye ọnụ ala dị ala (nri nri) n'oge TTM wee gbasaa mgbe ịmegharịghachi ahụ ma ọ bụrụ na achọrọ ya. Ọ bụrụ na a na-eji TTM nke 36°C dị ka okpomọkụ a na-atụ anya ya, ọnụego nri ntinye nwere ike ịbawanye na mbụ n'oge TTM.
• Anyị anaghị akwado iji ọgwụ nje prophylactic eme ihe mgbe niile.
4. amụma amụma
Ntuziaka izugbe
• Anyị adịghị akwado ọgwụ nje prophylactic maka ndị ọrịa na-amaghị ihe mgbe a kpọlitere ya site na njide obi, na neuroprognosis kwesịrị ime ya site na nyocha ụlọ ọgwụ, electrophysiology, biomarkers, na imaging, ma iji gwa ndị ikwu onye ọrịa na inyere ndị dọkịta aka ilekwasị anya ọgwụgwọ dabere na onye ọrịa ahụ. Ohere nke inweta mgbake akwara ozi bara uru (Foto 3).
• Ọ nweghị otu amụma ziri ezi 100%. Ya mere, anyị na-akwado usoro amụma amụma akwara ozi multimodal.
• Mgbe ị na-ebu amụma nsonaazụ akwara na-adịghị mma, a chọrọ nkọwa dị elu na izi ezi iji zere amụma ụgha na-enweghị isi.
• Nyocha nke akwara ozi nke ụlọ ọgwụ dị mkpa maka prognosis. Iji zere amụma na-ezighi ezi na-enweghị isi, ndị dọkịta kwesịrị ịzenarị mgbagwoju anya nke nsonaazụ ule nke nwere ike ịgbagwoju anya site n'ịkụnye ọgwụ na ọgwụ ndị ọzọ.
• A na-akwado nyocha ụlọ ọgwụ kwa ụbọchị mgbe a na-agwọ ndị ọrịa na TTM, mana nyocha nke ikpeazụ ga-eme nyocha mgbe emegharịrị.
• Ndị na-ahụ maka ụlọ ọgwụ ga-amata ihe ize ndụ nke iwebata amụma amụma nke onwe, nke na-eme mgbe a na-eji nsonaazụ nyocha index na-ebu amụma na-adịghị mma na mkpebi ọgwụgwọ, karịsịa n'ihe gbasara usoro ọgwụgwọ ndụ.
• Ebumnuche nke Neuroprognosis Index test bụ iji chọpụta oke mmerụ ụbụrụ hypoxic-ischemic. Neuroprognosis bụ otu n'ime akụkụ dị iche iche ị ga-atụle mgbe ị na-atụle ikike mmadụ nwere maka mgbake.
Ịma amụma ọtụtụ ụdị
• Malite nyocha prognostic site na nyocha ụlọ ọgwụ ziri ezi, nke emere naanị mgbe ewepụrụ ihe ndị na-agbagwoju anya (dịka ọmụmaatụ, ịhịa aka n'ahụ, hypothermia) (Njirimara 4)
• N'ịbụ ndị na-enweghị ihe mgbagwoju anya, ndị ọrịa na-ahụ maka ROSC ≥ M≤3 n'ime awa 72 nwere ike inwe mmetụta na-adịghị mma ma ọ bụrụ na abụọ ma ọ bụ karịa n'ime amụma ndị na-esonụ dị ugbu a: ọ dịghị nwa akwụkwọ corneal reflex na ≥ 72 h, na-anọghị n'akụkụ nke N20 SSEP ≥ 24h, EEG dị elu> awa 24, enolase neuronal kpọmkwem (NSE)> 60 μg / L maka 48 h na / ma ọ bụ 72 h, myoclonus steeti ≤ 72 h, ma ọ bụ ụbụrụ na-agbasa CT, MRI na nnukwu mmerụ ahụ hypoxic. Ọtụtụ n'ime ihe ịrịba ama ndị a nwere ike ịdekọ tupu 72 h nke ROSC; Agbanyeghị, a ga-enyocha nsonaazụ ha naanị n'oge nyocha prognostic ụlọ ọgwụ.
Nyocha ụlọ ọgwụ
• Nnwale ụlọ ọgwụ na-enwe ike ịnweta nnyonye anya site n'aka ndị na-enye ọgwụ na-edozi ahụ, opioids, ma ọ bụ ihe na-eme ka ahụ dị jụụ. Enwere ike inwe mgbagwoju anya site na ịhịa aka n'ahụ fọdụrụnụ kwesịrị ịtụle ma wepụ ya.
• Maka ndị ọrịa na-anọgide na coma 72 awa ma ọ bụ mgbe e mesịrị ka ROSC gasịrị, ule ndị na-esonụ nwere ike ịkọ amụma gbasara akwara ozi ka njọ.
• N'ime ndị ọrịa na-anọgide na-agbake awa 72 ma ọ bụ mgbe e mesịrị ka ROSC gasịrị, ule ndị a nwere ike ịkọ ihe ọjọọ na-adịghị mma nke akwara ozi:
- Enweghị nlegharị anya ọkụ ụmụ akwụkwọ n'akụkụ abụọ
- Ọnụ ọgụgụ nke ụmụ akwụkwọ
– Mfu nke corneal reflex n'akụkụ abụọ
- Myoclonus n'ime awa 96, ọkachasị steeti myoclonus n'ime awa 72
Anyị na-akwadokwa ịdekọ EEG n'ihu myoclonic tics iji chọpụta ọrụ epileptiform ọ bụla metụtara ma ọ bụ iji chọpụta akara EEG, dị ka nzaghachi azụ azụ ma ọ bụ n'ihu, na-atụ aro ike maka mgbake akwara ozi.
neurophysiology
• A na-eme EEG (electroencephalogram) na ndị ọrịa na-efunahụ onwe ha mgbe ejiri obi nwude.
• Usoro EEG dị njọ nke ukwuu gụnyere nzụlite nkwụchi nwere ma ọ bụ na-enweghị mwepu oge na mgbawa. Anyị na-akwado iji usoro EEG ndị a dị ka ihe na-egosi prognosis na-adịghị mma mgbe njedebe nke TTM na mgbe ịgbatị ahụ gasịrị.
• Ọnụnọ nke njide doro anya na EEG n'ime awa 72 mbụ mgbe ROSC gasịrị bụ ihe na-egosi na-adịghị mma.
• Enweghị nzaghachi azụ azụ na EEG bụ ihe na-egosi na-adịghị mma prognosis mgbe e jidere obi obi.
• Mbelata nke somatosensory nke abụọ na-akpata nke cortical N20 nwere ike bụ ihe na-egosi amụma na-adịghị mma mgbe ejidere obi.
• A na-atụlekarị nsonaazụ EEG na somatosensory evoked potentials (SSEP) na nyocha nke ụlọ ọgwụ na nyocha ndị ọzọ. A ghaghị ịtụle ọgwụ mgbochi neuromuscular mgbe a na-eme SSEP.
Biomarkers
• Jiri ụdị nha NSE dị iche iche yana nchikota yana ụzọ ndị ọzọ iji buru amụma ihe ga-esi na ya pụta ma e jidechara obi. Ọnụ ahịa dị elu na awa 24 ruo 48 ma ọ bụ awa 72, jikọtara ya na ụkpụrụ dị elu na awa 48 ruo 72, na-egosi amụma na-adịghị mma.
Onyonyo
• Jiri ọmụmụ ihe onyonyo ụbụrụ buru amụma na-adịghị mma nke akwara ozi mgbe ejidechara obi yana yana ndị amụma amụma ndị ọzọ na ụlọ ọrụ nwere ahụmịhe nyocha dị mkpa.
• Ọnụnọ nke edema nke ụbụrụ n'ozuzu ya, gosipụtara site na mbelata akara nke isi awọ / ọcha na ụbụrụ CT, ma ọ bụ njedebe mgbasa ozi zuru oke na ụbụrụ MRI, na-ebu amụma amụma na-adịghị mma na-adịghị mma mgbe e jidere obi obi.
• A na-atụlekarị nchoputa onyonyo yana nchikota na ụzọ ndị ọzọ iji buru amụma amụma akwara ozi.
5. Kwụsị ọgwụgwọ na-edobe ndụ
• Mkparịta ụka dị iche iche nke ntule prognosis nke nkwụghachi na mgbake akwara nke ọgwụgwọ ndụ na-adịgide adịgide (WLST); Mkpebi na WLST kwesịrị iburu n'uche akụkụ ndị ọzọ na-abụghị mmerụ ụbụrụ, dị ka afọ, nsogbu, ọrụ akụkụ ahụ, na nhọrọ onye ọrịa.
Wepụta oge zuru oke maka nkwurịta okwu, amụma ogologo oge mgbe ejiri obi nwude
Ọkwa ọgwụgwọ n'ime otu ahụ na-ekpebi ma na-eme nyocha ọrụ anụ ahụ na nke na-abụghị nke ikwu na ndị ikwu. Nchọpụta mmalite nke mkpa ndozigharị maka nkwarụ anụ ahụ tupu ahapụ ya na ịnye ọrụ nhazigharị mgbe ọ dị mkpa. (Foto nke 5).
• Hazie nleta nleba anya maka ndị niile lanarịrị ejide obi n'ime ọnwa 3 nke nchụpụ, gụnyere ndị a:
- 1. Ihuenyo maka nsogbu uche.
2. Ihuenyo maka nsogbu ọnọdụ uche na ike ọgwụgwụ.
3. Nye ozi na nkwado nye ndị lanarịrịnụ na ezinụlọ.
6. Onyinye akụkụ
• Mkpebi niile gbasara inye onyinye akụkụ ahụ ga-agbasorịrị iwu obodo na ụkpụrụ omume.
• Ekwesịrị ịtụle inye onyinye akụkụ maka ndị na-ezute ROSC wee zute njirisi maka ọnwụ akwara ozi (Nyocha 6).
• N'ime ndị ọrịa na-eku ume na-eku ume nke na-emezughị ụkpụrụ maka ọnwụ akwara ozi, a ga-atụle inye onyinye akụkụ ahụ n'oge a na-ejide ọbara ma ọ bụrụ na e mere mkpebi ịmalite ọgwụgwọ njedebe na ịkwụsị nkwado ndụ.
Oge nzipu: Jul-26-2024