(1)复苏成功。
(2)经约30min BLS和ALS-CPR的抢救,心肌活动毫无反应。可考虑停止复苏术。
(3)我国现在尚未制订“脑死亡”条例,国外,如法国,已有法律规定,做两次脑电图,均无脑活动表现,并经两位主治医师鉴定,明确为脑死亡,复苏术可以中止。
心脏骤停后复苏的成败关键在于是否尽早开始BLS和ALS的CPR措施。因此必须在现场就开始CPR术,并在将病人安全地转运途中继续治疗,至接收医院急诊室(早就组建了急救网)进一步抢救。除了胸外按压和人工呼吸,早行气管插管联接呼吸机和电击除颤已越来越显示其重要性。然后建立静脉通道、监测病人循环、呼吸功能以及其他生理指标。根据所得参数,给以相应药物。第一线药物是肾上腺素、阿托品、溴苄胺和利多卡因。
脑复苏是很关键的问题,目前虽然尚无肯定的恢复脑功能的药物,但对脑组织缺氧性缺血时的病理生理变化的研究正逐步深入,解决脑复苏的办法已不会是很远。
心脏骤停的复苏过程间接反映了急诊医疗体系三个组成部分的密切关系与协调组合:院前抢救、医院急诊室与ICU或CCU监护强化病室。
(邵孝鉷)
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