目的系统评价体外序贯双除颤(DSED)对顽固性室颤患者自主循环恢复(ROSC)的影响。方法检索中英文数据库Web of science、EMBASE、Medline及万方数据库、中国学术期刊全文数据库、中国生物医学文献数据库等,筛选发表至2022年3月的顽固性...目的系统评价体外序贯双除颤(DSED)对顽固性室颤患者自主循环恢复(ROSC)的影响。方法检索中英文数据库Web of science、EMBASE、Medline及万方数据库、中国学术期刊全文数据库、中国生物医学文献数据库等,筛选发表至2022年3月的顽固性室颤使用DSED的观察性研究和随机对照研究。结果共纳入5篇文献,其中1篇为随机对照研究,4篇为观察性研究。纳入1152例院外心脏骤停(out-of hospital cardiac arrest,OHCA)顽固性室颤患者,其中272例接受DSED,880例接受标准除颤。DSED组和标准除颤组患者ROSC分别为33.1%和39.0%,OR=0.75(95%CI 0.55~1.01,P=0.06),室颤终止分别为51.5%和53.6%,OR=0.74(95%CI 0.55~1.00,P=0.05)。两组患者入院时存活率和出院时存活率差异无统计学意义。结论DSED未增加顽固性室颤患者ROSC成功率。展开更多
Background:Heart rate variability(HRV)reveals information on the functional state of the autonomic nervous system(ANS)in neonates.During severe illness,heart rate variability is impaired.Aim:This study was initiated t...Background:Heart rate variability(HRV)reveals information on the functional state of the autonomic nervous system(ANS)in neonates.During severe illness,heart rate variability is impaired.Aim:This study was initiated to measure th e changes in HRV in neonates during extracorporeal membrane oxygenation(ECMO)a nd recovery from severe respiratory and circulatory failure.Moreover,we compar ed our data with HRV data of healthy newborns and we investigated the difference s in HRV parameters between ECMO-survivors and non-survivors.Study design:Th is study is of an observational character.We performed short-term recordings o f heart rate variability in 14 neonates during ECMO and recovery.We computed ti me-and frequency-domain HRV parameters.Results:ECMO significantly affects ti me-domain HRV parameters.Severe neonatal illness causes a significant reductio n of all calculated HRV parameters;clinical recovery is accompanied by an incre ase of HRV.In comparison with normative data of healthy newborns,however,HRV remains impaired.The ECMO-development ratio s eparated the non-survivors from the survivors during ECMO therapy.Conclusions:During severe neonatal illness,HRV is impaired.It remains to be clarified whe ther the impairment of HRV during severe illness can predict the neurological ou tcome.The ability of the E/D ratio as an HRV parameter to serve as a predictive tool has to be corroborated in larger group of patients.展开更多
目的基于情景的高仿真模拟方法(下面统称情景模拟)指挥团队进行心肺复苏(CPR)在急诊住院医师规范化培训二阶段考核中的应用效果评价。方法选择参加2019、2020年北京市急诊住院医师规范化培训二阶段考核(急诊住院医师培训满5年)的191名...目的基于情景的高仿真模拟方法(下面统称情景模拟)指挥团队进行心肺复苏(CPR)在急诊住院医师规范化培训二阶段考核中的应用效果评价。方法选择参加2019、2020年北京市急诊住院医师规范化培训二阶段考核(急诊住院医师培训满5年)的191名急诊科住院医师为研究对象,二阶段考核内容其中一项为情景模拟下考生指挥团队进行CPR。根据研究对象的调查问卷,将其分为临床工作中未曾独立组织CPR抢救组(n=63)和曾经独立组织CPR抢救组(n=128);同时还分为既往未曾接受过情景模拟培训组(n=57)和曾经接受过情景模拟培训组(n=134)。分别比较两组心脏骤停(cardiac arrest,CA)之前的病情判断、CA的抢救措施、气道管理、胸外按压(按压深度、按压是否回弹、按压频率)、不间断按压、电除颤(能量选择、除颤位置、除颤时机)、自主呼吸循环恢复(return of spontaneous circulation,ROSC)后的处理、人文关怀、团队合作(领导力)和此项考核的总成绩。结果未曾独立组织CPR抢救组CA之前的病情判断、CA的抢救措施、间断按压、除颤时机、ROSC后的处理、人文关怀、团队合作(领导力)及考核总成绩均显著低于曾经独立CPR抢救组,差异有统计学意义(P<0.05);而两组气道管理、胸外按压(深度、频率、回弹)、电除颤(能量选择、除颤位置)比较差异无统计学意义(P>0.05)。未曾接受培训组CA之前的病情判断、CA的抢救措施、不间断按压、除颤时机、ROSC后的处理、人文关怀、团队合作(领导力)及总成绩均显著低于曾经接受培训组,差异有统计学意义(P<0.05);而两组在气道管理、胸外按压(深度、频率、回弹)、电除颤(能量选择、除颤位置)上差异无统计学意义(P>0.05)。结论应用情景模拟方法作为急诊住院医师规范化培训二阶段考核方式,可真实地反映出急诊高年资住院医师的临床急救能力与核心能力。开展基于情景的高仿真模拟培训,有利于提升规培医师抢救时的综合能力。展开更多
文摘Background:Heart rate variability(HRV)reveals information on the functional state of the autonomic nervous system(ANS)in neonates.During severe illness,heart rate variability is impaired.Aim:This study was initiated to measure th e changes in HRV in neonates during extracorporeal membrane oxygenation(ECMO)a nd recovery from severe respiratory and circulatory failure.Moreover,we compar ed our data with HRV data of healthy newborns and we investigated the difference s in HRV parameters between ECMO-survivors and non-survivors.Study design:Th is study is of an observational character.We performed short-term recordings o f heart rate variability in 14 neonates during ECMO and recovery.We computed ti me-and frequency-domain HRV parameters.Results:ECMO significantly affects ti me-domain HRV parameters.Severe neonatal illness causes a significant reductio n of all calculated HRV parameters;clinical recovery is accompanied by an incre ase of HRV.In comparison with normative data of healthy newborns,however,HRV remains impaired.The ECMO-development ratio s eparated the non-survivors from the survivors during ECMO therapy.Conclusions:During severe neonatal illness,HRV is impaired.It remains to be clarified whe ther the impairment of HRV during severe illness can predict the neurological ou tcome.The ability of the E/D ratio as an HRV parameter to serve as a predictive tool has to be corroborated in larger group of patients.
文摘目的基于情景的高仿真模拟方法(下面统称情景模拟)指挥团队进行心肺复苏(CPR)在急诊住院医师规范化培训二阶段考核中的应用效果评价。方法选择参加2019、2020年北京市急诊住院医师规范化培训二阶段考核(急诊住院医师培训满5年)的191名急诊科住院医师为研究对象,二阶段考核内容其中一项为情景模拟下考生指挥团队进行CPR。根据研究对象的调查问卷,将其分为临床工作中未曾独立组织CPR抢救组(n=63)和曾经独立组织CPR抢救组(n=128);同时还分为既往未曾接受过情景模拟培训组(n=57)和曾经接受过情景模拟培训组(n=134)。分别比较两组心脏骤停(cardiac arrest,CA)之前的病情判断、CA的抢救措施、气道管理、胸外按压(按压深度、按压是否回弹、按压频率)、不间断按压、电除颤(能量选择、除颤位置、除颤时机)、自主呼吸循环恢复(return of spontaneous circulation,ROSC)后的处理、人文关怀、团队合作(领导力)和此项考核的总成绩。结果未曾独立组织CPR抢救组CA之前的病情判断、CA的抢救措施、间断按压、除颤时机、ROSC后的处理、人文关怀、团队合作(领导力)及考核总成绩均显著低于曾经独立CPR抢救组,差异有统计学意义(P<0.05);而两组气道管理、胸外按压(深度、频率、回弹)、电除颤(能量选择、除颤位置)比较差异无统计学意义(P>0.05)。未曾接受培训组CA之前的病情判断、CA的抢救措施、不间断按压、除颤时机、ROSC后的处理、人文关怀、团队合作(领导力)及总成绩均显著低于曾经接受培训组,差异有统计学意义(P<0.05);而两组在气道管理、胸外按压(深度、频率、回弹)、电除颤(能量选择、除颤位置)上差异无统计学意义(P>0.05)。结论应用情景模拟方法作为急诊住院医师规范化培训二阶段考核方式,可真实地反映出急诊高年资住院医师的临床急救能力与核心能力。开展基于情景的高仿真模拟培训,有利于提升规培医师抢救时的综合能力。
