心脏骤停后综合征的治疗进展

Treatment progress of post - cardiac arrest syndrome

心脏骤停是临床最危急的病症，如不及时救治短时间内可致患者死亡。随着建立在大量临床干预研究及新技术发展基础上的心肺复苏指南的不断更新，自主循环恢复（ROSC）比率大幅度提高，但目前心脏骤停患者存活率仍然很低。心脏骤停后综合征（PCAS）为心脏骤停患者ROSC后较长时间严重的全身缺血一再灌注综合征，涉及一系列复杂的病理生理改变，包括心脏骤停后脑损伤、心脏骤停后心肌功能异常、全身缺血一再灌注损伤和持续的致病因素。目前，对PCAS的处理已成为改善心脏骤停生存链的重要一环，逐渐为广大临床医务人员所重视。对心肺复苏恢复自主循环的患者最迫切治疗是优化全身血液灌注，维持各器官系统功能。对疑有急性冠状动脉综合征（ACS）患者应早期行经皮冠状动脉介入术（PCI）治疗。维持适当通气并保证动脉氧饱和度在94％～96％。临床亚低温治疗是目前唯一临床证实有效的脑保护技术，对PCAS后昏迷患者应尽早实施。对高血糖的PCAS患者应使用胰岛素控制血糖在正常范围。对于行机械通气及亚低温治疗的患者给予镇静剂可以降低氧耗并加快低温诱导。关于神经保护药物及激素应用疗效还有待于进一步研究。

Postcardiac arrest syndrome （PCAS） is the most critical clinical disease, the patients will die within a short time without timely treatment. With the updated Guidelines for Cardiopulmonary Resuscitation on the basis of a large number of clinical study and the development of new technologies, recovery rate of spontaneous circulation was much higher, but survival rates after cardiac arrest remain disappointingly low. PCAS is considered as a severe systemic ischemia - reperfusion syndrome after ROSC, involves in a series of complex pathophysiology changes, including post- cardiac arrest brain injury, post -cardiac arrest myocardial dysfunction, systemic ischemia- reperfusion injury and persistent pathogenic factors. Currently the treatment of PCAS has become an important part of the survival chain, and gradually gains more attentions from clinical medical staff. For the patients after ROSC, the most urgent treatment is to optimize systemic perfusion and maintain the organ system function. Patients with suspected ACS should be treated with percutaneous coronary intervention early. Oxygen saturation is maintained 94% to 96% by proper ventilation. Clinical therapeutic hypothermia is proved to be the only effective technology of cerebra/ protection at present, and early hypothermia is necessary for the comatose patients. Insulin is used to control blood sugar at the normal range for patients with high blood sugar. Sedative is used to reduce oxygen consumption and speed inducing hypothermia for the patients with mechanical ventilation or mild hypothennia. As for the effects of neuroprotective drugs and hormones needs to be further researched.