《中国心肺复苏专家共识》之孕产妇心搏骤停防治救指南

Chinese consensus of cardiopulmonary resuscitation guides prevention, treatment and rescue of cardiac arrest in pregnancy

孕妇作为特殊时期的一组人群,一旦出现突发心搏骤停(CA)会威胁到母子两人的生命。最大限度地降低孕产妇死亡,确保围产期母子全程平安,成为医疗机构和医护人员要面对的巨大挑战。与相同年龄普通CA患者的心肺复苏施救策略不同,孕期CA患者施救需要考虑患者的孕龄、胎儿情况等,采用不同的复苏手法如左推子宫(MLUD),会涉及濒死剖宫产(PMCD);同时针对导致孕期CA的不同原因如出现4Hs中的低氧血症、低血容量、高血钾或低血钾及其他电解质紊乱、低体温,以及4Ts中的血栓形成、心包填塞、张力性气胸和中毒等情况的合理药物应用。针对导致孕期CA的原因中多种情况为可预防性的特点,更有必要出台符合我们国情的孕期CA指南以指导临床。本文系统梳理了孕期CA的病理生理特点,孕期CA的高危因素,明确了孕期CA的正确复苏方法和防治策略。

Pregnant women are a group of people in a special period,once sudden cardiac arrest(CA)occurs,it will threaten the life of both mother and child.It has become a great challenge for hospital,doctors and nurses to minimize maternal mortality during pregnancy.All the efforts should ensure the safety of both mother and child throughout the perinatal period.Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age,the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition.Different resuscitation techniques,such as manual left uterine displacement(MLUD),will involve perimortem cesarean delivery(PMCD).At the same time,drugs should be reasonably used for different causes of CA during pregnancy,such as hypoxemia,hypovolemia,hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs,as well as thrombosis,pericardial tamponade,tension pneumothorax and toxicosis in 4Ts.In view of the fact that many causes of CA in pregnancy are preventable,it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance.This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy,the high-risk factors of CA during pregnancy,and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.