Application of Positron Emission Tomography in the Detection of Myocardial Metabolism in Pig Ventricular Fibrillation and Asphyxiation Cardiac Arrest Models after Resuscitation

Objective To study the application of positron emission tomography （PET） in detection of myocardia metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation. Methods Thirty-two healthy miniature pigs were randomized into a ventricular fibrillation cardiac arrest （VFCA） group （n=16） and an asphyxiation cardiac arrest （ACA） group （n=16）. Cardiac arrest （CA） was induced by programmed electric stimulation or endotracheal tube clamping followed by cardiopulmonary resuscitation （CPR） and defibrillation. At four hours and 24 h after spontaneous circulation was achieved, myocardial metabolism was assessed by PET. 18F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value （SUVmax） was measured. Results Spontaneous circulation was 200% and 62.5% in VFCA group and ACA group, respectively. PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA. The SUVrnax was higher in VFCA group than in ACA group （P〈0.01）. In VFCA group, SUVmax at 24 h after spontaneous circulation increased to the level of baseline. Conclusion ACA causes more severe cardiac metabol associated with less successful resuscitation. Myocardial sm injuries than VFCA. Myocardial dysfunction is stunning does occur with VFCA but not with ACA.

Neutrophil-lymphocyte ratio:A prognostic tool in patients with inhospital cardiac arrest

BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.

Brugada syndrome associated with out-of-hospital cardiac arrest: A case report

BACKGROUND Brugada syndrome(BrS)is an inherited disease characterized by an electrocardiogram(ECG)with a coved-type ST-segment elevation in the right precordial leads(V1-V3),which predisposes to sudden cardiac death(SCD)due to polymorphic ventricular tachycardia or ventricular fibrillation in the absence of structural heart disease.We report the case of a 29-year-old man with out-ofhospital cardiac arrest.BrS is associated with a high incidence of SCD in adults,and increasing the awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.CASE SUMMARY A 29-year-old man suffered from out-of-hospital cardiac arrest,and after defibrillation,his ECG demonstrated a coved-type elevated ST segment in V1 and V2.These findings were compatible with type 1 Brugada pattern,and ECG of his brother showed a type 2 Brugada pattern.The diagnosis was BrS,NYHF IV,multiple organ dysfunction syndrome,sepsis,and hypoxic ischemic encephalopathy.The patient had no arrhythmia episodes after discharge throughout a follow-up period of 36 mo.CONCLUSION Increasing awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.

Comparison of Cerebral Metabolism between Pig Ventricular Fibrillation and Asphyxial Cardiac Arrest Models

Background：Morbidity and mortality after resuscitation largely depend on the recovery of brain function.Ventricular fibrillation cardiac arrest （VFCA） and asphyxial cardiac arrest （ACA） are the two most prevalent causes of sudden cardiac death.Up to now,most studies have focused on VFCA.However,results from the two models have been largely variable.So,it is necessary to characterize the features of postresuscitation cerebral metabolism of both models.Methods：Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups：18 for VFCA group,ACA group,respectively,and other 8 for sham-operated group （SHAM）.VFCA was induced by programmed electric stimulation,andACA was induced by endotracheal tube clamping.After 8 min without treatment,standard cardiopulmonary resuscitation （CPR） was initiated.Following neurological deficit scores （NDS） were evaluated at 24 h after achievement of spontaneous circulation,cerebral metabolism showed as the maximum standardized uptake value （SUVmax） was measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography.Levels of serum markers of brain injury,neuron specific enolase （NSE）,and S100β were quantified with an enzyme-linked immunosorbent assay.Results：Compared with VFCA group,fewer ACA animals achieved restoration of spontaneous circulation （61.1% vs.94.4%,P 〈 0.01） and survived 24-h after resuscitation （38.9% vs.77.8%,P 〈 0.01） with worse neurological outcome （NDS：244.3 ± 15.3 vs.168.8 ± 9.71,P 〈 0.01）.The CPR duration of ACA group was longer than that of VFCA group （8.1 ± 1.2 min vs.4.5 ± 1.1 min,P 〈 0.01）.Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA （P 〈 0.05 or P 〈 0.01）.Higher serum biomarkers of brain damage （NSE,S100β） were found inACA than VFCA after resuscitation （P 〈 0.01）.Conclusions：Compared with VFCA,ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.

Nifekalant in the treatment of life-threatening ventricular tachyarrhythmias

The aim of the present study is to review the literature and discuss nifekalant's potential use as a first aid drug in an emergency care setting.The PubMed database was used to identify papers,using Keywords nifekalant,MS-551,amiodarone and lidocaine.Nifekalant hydrochloride,formally known as MS-551,is a classⅢ antiarrhythmic agent which acts only by increasing the time course of myocardial repolarization.It was developed and is currently being used only in Japan for the treatment of ventricular tachyarrhythmias.It is a non-selective K+channel blocker without any β-blocking actions.Administration of nifekalant suppressed sustained ventricular tachyarrhythmias in acute coronary syndrome patients,and in cardiac arrest victims as well as during or after cardiac surgery.The major adverse effect of nifekalant is QT interval prolongation and occurrence of torsades de pointes which requires frequent monitoring of the QT interval during nifekalant infusion with adequate dose adjustment.Nifekalant is a possible effective antiarrhythmic agent for refractory ventricular tachyarrhythmias.Further clinical studies are required before nifekalant is routinely used in the emergency care setting.

Distinct properties and metabolic mechanisms of postresuscitation myocardial injuries in ventricular fibrillation cardiac arrest versus asphyxiation cardiac arrest in a porcine model

Background The two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest （VFCA） and asphyxiation cardiac arrest （ACA）. Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models. Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction. Methods Thirty-two pigs were randomized into two groups. The VFCA group （n=16） were subject to programmed electrical stimulation and the ACA group （n=16） underwent endotracheal tube clamping to induce cardiac arrest （CA）. Once induced, CA remained untreated for a period of 8 minutes. Two minutes following initiation of cardiopulmonary resuscitation （CPR）, defibrillation was attempted until return of spontaneous circulation （ROSC） was achieved or animals died. To assess myocardial metabolism, 18F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC. Results ROSC was 100% successful in VFCA and 50% successful in ACA. VFCA had better mean arterial pressure and cardiac output after ROSC than ACA. Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC （ROSC 0.5 hours, pH： 7.01±0.06 vs. 7.21±0.03, P〈0.01; HCO3： （15.83±2.31 vs. 20.11±1.83） mmol/L, P〈0.01; lactate： （16.22±1.76 vs. 5.84±1.44） mmol/L, P〈0.01）. Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC （the maximum standardized uptake value of the whole left ventricular： 1.00±0.17 vs. 1.93±0.27, P〈0.01）. Lower contents of myocardial energy metabolism enzymes （Na＊-K＊-ATPase enzyme activity, Ca2＊- ATPase enzyme activity, superoxide dismutase and phosphodiesterase） were found in ACA relative to VFCA. Conclusions Compared with VFCA, ACA causes more severe myocardium injury and metabolism hindrance, therefore they should be treated as different pathological entities.

Ventricular fibrillation as primary presentation of takotsubo cardiomyopathy after complicated cesarean delivery

Takotsubo cardiomyopathy typically affects post-menopausal women under severe psychological or physical stress; it also has been reported to develop after medical procedures or surgery. We herein report the rare case of a 30-year-old woman who presented with an episode of ventricular fibrillation after a very complicated cesarean delivery and was successfully resuscitated. Subsequent electrocardiography and echocardiography showed a typical Takotsubo pattern. Within 3 wk, left ventricular systolic function returned to normal.

长时程室颤先行心肺复苏对复苏效果的影响及机制研究

目的比较7 min室颤先行心肺复苏2 min后除颤与直接除颤的复苏效果,并探讨其机制。方法建立猪闭胸电诱发室颤模型,CPR First组优先心肺复苏2 min后连续三次除颤,Shock First组直接予连续三次除颤,观察冠脉灌注压、室颤波频率和振幅变化,计算除颤成功率和自主循环恢复率。结果CPR First组先行心肺复苏2 min后可提高初次除颤前的冠脉灌注压、室颤波的频率和振幅,CPR First组比Shock First组有高的除颤成功率和自主循环恢复率(P<0.05)。结论7 min室颤除颤前先行胸外按压和人工呼吸可明显提高复苏成功率,其机制与增加冠脉灌注,改善心脏能量储备,提高室颤波的频率和振幅有关。

经食道-胸壁电刺激建立兔心脏骤停模型

【目的】建立一种更为简单、便捷、成功率高的兔心脏骤停模型。【方法】经食道插入食道调搏电极至心脏水平,在心前区心搏最明显处皮下插入针灸针形成电流回路,用恒定35mA交流电诱发心脏骤停,无干预观察5 min后进行心肺复苏。分别记录15只新西兰大白兔达到心脏骤停标准的时间、停止刺激时的心律、复苏开始前的心律、心肺复苏时间、除颤次数、给药次数、自主循环恢复率、自主循环恢复后机械通气时间、自主循环恢复后生存时间及72 h生存率。【结果】本实验中的15只兔全部诱发心脏骤停成功。从有效电刺激开始到成功诱发心脏骤停的时间为(26±10)s。电刺激结束时室颤发生率为100%(15/15),无心脏停搏及无脉性电活动发生,在无干预观察期内无自动复律现象。在心肺复苏开始时心电图表现为室颤的比例为73.3%(11/15),无脉性电活动的比例为26.7%(4/15)。心肺复苏用时(200±136)s,除颤次数(1.00±0.76)次,静脉注射肾上腺素次数(2.40±1.12)次,自主循环恢复率93.3%(14/15),自主循环恢复后机械通气时间(40±17)min。自主循环恢复后0～6 h死亡率为6.7%(1/15),6～24 h内死亡率60(9/15),24～72 h时存活率为26.6%(4/15)。【结论】经食道-胸壁定流电刺激方式诱发兔心脏骤停模型操作简单、重复性好、复苏成功率高,并发症少,是一个较为理想的研究心肺脑复苏的模型。

胸腔镜下室间隔缺损修补术

目的 探讨胸腔镜下室间隔缺损修补术。 方法 16例先天性心脏病 (男 10例 ,女 6例 )。年龄 (6～ 2 7)岁。 (14± 7)岁 ,体重 (17～ 6 7)kg ,(38 5± 16 8)kg。采用股动静脉插管 ,在患者右侧第四肋间胸骨旁、第四肋间腋中线、第七肋间腋中线各打一个直径 1cm～ 3cm的孔 ,经第四肋间腋中线插入上腔静脉插管 ,建立体外循环 ,阻闭升主动脉 ,冠脉冷灌 ,心脏停搏 ,切开并悬吊右心房 ,显露三尖瓣及室间隔缺损 ,缝合室间隔缺损 ,缝合右心房切口 ,开放升主动脉。 结果 16例手术均获成功 ,主动脉阻闭时间 (2 7～ 6 7)min ,(43± 13)min。体外循环时间 (6 6～ 16 8)min ,(95± 33)min。术后心脏杂音消失 ,心脏超声检查示无心内分流。 结论 胸腔镜下可完成室间隔缺损修补术的全部心内操作。也为室间隔缺损修补术提供了另一种选择。

心肌梗死后骨髓间充质干细胞治疗改进心功能及心肺复苏结果的研究

【目的】探索大鼠心肌梗死并经骨髓间充质干细胞(MSC)治疗后,心功能的变化及对其后进行的心肺复苏结果的影响。【方法】18只雄性Sprague-Dawley大鼠,随机分为两组,MSC注射组和磷酸缓冲液(PBS)注射组,每组9只大鼠。先开胸结扎左前降支冠状动脉,4周后再次开胸接受PKH26荧光标记的悬浮在PBS中的5×106MSC或仅用PBS梗死部位注射治疗,注射后2周及4周用超声心动图测量射血分数,4周时诱导心室颤动及进行心肺复苏,测量心肺复苏前及心肺复苏后4 h内的血液动力学参数的变化。并在心肺复苏72 h后取心肌组织进行病理切片检查。【结果】与注射磷酸缓冲液相比,注射MSC 2周(67%±4%vs 56%±5%,P<0.001)及4周后(67%±6%vs 53±13%,P<0.01)射血分数明显提高,心肺复苏前后的血液动力学参数包括心脏指数、dp/dt40、-dp/dt、左心室舒张末期压明显改善;虽然2组的复苏成功率没有明显区别,但72 h生存率2组比较有明显差异(58.6±20.6 vs 26.1±21.6,P<0.05)。心肌组织病理切片发现有大量的PKH26标记的细胞存在。【结论】心肌梗死后MSC治疗能明显改善心功能,同时也能明显改善心肺复苏前后的血流动力学参数及72 h生存时间。

心脏骤停猪复苏期间动静脉血气的分析

目的比较心脏骤停猪复苏中动、静脉血气的变化，以了解动静脉血气结果对判断复苏效果的意义。方法24头家猪电刺激制作心脏骤停心室纤颤（VF）模型，VF后9min后进行CPR，并分别抽取复苏前后动脉（CA）和混合静脉（MV）血进行分析。结果VF期间PmvO：较vF前明显下降（P〈0．05），而PmvC02明显升高（P〈0．01）。中心动脉及外周动脉血气均示pH值及乳酸（Lac）升高，而HC03-值较正常均有降低；混合静脉血示pH值降低，而Lac逐渐升高。结论复苏期间存在氧供和酸碱失衡，分析静脉血气对了解机体组织的氧合和酸碱状态更切合临床实际。

窒息法和室颤法诱导建立大鼠心脏停搏模型的比较

目的·比较室颤和窒息2种方法诱导的心脏停搏动物模型在成模大鼠心功能和神经功能的差异。方法·20只成年健康雄性SD大鼠随机分为3组:按室颤法(n=8)和窒息法(n=8)建立心脏停搏-复苏动物模型,另4只SD大鼠作为空白对照假手术组。所有成模大鼠均观察24 h,其中呼吸机等生命支持1 h。比较2个模型组大鼠复苏后心电变化,复苏后1、3、5、6 h的射血分数(ejection fraction,EF)及心输出量(cardiac output,CO),复苏后6、12、18、24 h的神经功能缺失评分(neurological deficit score,NDS)及24 h生存率等方面的差异。结果·2个模型组大鼠复苏后,CO和EF较同时期假手术组均明显下降(P=0.000)。复苏后1 h,室颤组CO由(98.84±4.86)m L/min下降至(59.17±22.99)m L/min,窒息组CO由(99.86±10.34)m L/min下降至(46.02±22.32)m L/min,但2组间差异无统计学意义(P=0.792)。随着时间延长,室颤组CO逐渐恢复;在复苏后3、5、6 h,室颤组CO均高于窒息组,且差异具有统计学意义(P=0.041,P=0.007,P=0.020)。复苏后1 h,室颤组EF由(82.17±6.21)%下降至(70.23±13.24)%,窒息组由(83.24±3.01)%下降至(65.46±13.11)%,但2组间差异无统计学意义(P=0.877)。随着时间延长,EF也呈逐渐恢复趋势,室颤组更为明显;在复苏后3、5 h,室颤组EF均高于窒息组,且差异具有统计学意义(P=0.031,P=0.024)。室颤组24 h生存率75.0%,窒息组62.5%,差异无统计学意义(P=0.393)。复苏后2组大鼠神经功能受损明显,NDS明显低于基础值,随着时间延长有改善趋势,室颤组神经系统预后似优于窒息组,但差异无统计学意义。结论·室颤和窒息同为诱导心脏停搏的常用方法,但是2种模型在复苏后心功能方面略有差异。研究中应结合自己的需要选择合适的模型。

冠脉循环微血管病变与老年高血压左室肥厚患者的心脏事件

目的 探讨老年高血压左室肥厚患者冠脉循环微血管病理改变与心脏事件的关系。方法 从我院 195 4～1996年间连续尸检 3195例的心脏标本中选取≥ 6 0岁 ,经临床和病理证实的高血压患者共 15 8例 (高血压 71例 ,高血压合并冠心病 6 2例 ,高血压合并冠心病和糖尿病 2 5例 )进行下列测定 :(1)左室肥厚 (LVH)分级 ;(2 )冠状动脉粥样硬化 (CAS)狭窄分级 ;(3)主动脉粥样硬化 (AAS)分级 ;(4)心肌微动脉密度 :直径 10～ 6 0 μm有内弹力板的心肌微动脉数 ;(5 )心肌微动脉壁腔比值 ;(6 )心肌毛细血管密度及其内皮细胞面积。结果 本组病理资料Logistic分析证实 ,老年高血压左室肥厚患者心脏事件的影响因素 ,按相关程度高低依次为心肌微动脉壁腔比值 (r =0 .1783,P=0 .0 0 5 5 ,OR=12 .72 0 4) ,CAS (r=0 .1738,P =0 .0 0 6 4,OR=2 .340 9) 及心肌微动脉密度 (r=- 0 .12 2 3,P=0 .0 30 4,OR =0 .6 10 1)。结论 冠脉循环微动脉病变程度及CAS程度是影响老年高血压左室肥厚患者心脏事件发生率的主要因素 。

心肺复苏后吸入七氟醚通过调控Bcl—2／Bax减少神经元凋亡

目的 观察大鼠心肺复苏（CPR）自主循环恢复（ROSC）后吸入七氟醚对大脑皮层神经细胞凋亡的影响。方法 建立大鼠室颤后CPR模型（VF/CPR）。30只Wistar大鼠随机分为假手术组（Sham group）6只，七氟醚组（Sevo group）12只，对照组（Control group）12只。Sham组仅麻醉及气管插管，Sevo组在ROSC后立即吸入2.4%七氟醚10 min，Control组常规心肺复苏。ROSC 24 h后采用神经缺损评分（Neuro-Deficit Scoring, NDS）量表对大鼠神经功能进行评分；电镜观察线粒体损伤程度和TUNEL法对大脑皮层神经元细胞凋亡进行检测； Western blot检测Bcl-2、Bax和细胞色素C的蛋白表达水平，免疫组化检测活化的半胱氨酸蛋白酶（Cleaved-Caspase 3）的蛋白表达水平。结果 实验前三组动物体质量、心率、平均动脉压差异无统计学意义，复苏中的CPR时间、除颤次数、肾上腺素使用剂量差异无统计学意义。ROSC 24 h后，Sevo组的NDS评分明显高于Control组。电镜下，Sevo组线粒体结构损害程度较轻；TUNEL法显示，凋亡细胞比例明显低于Control组［（12±6）% vs.（22±8）%，P＜0.01］。其次，Sevo组Bcl-2/Bax蛋白比值明显高于Control组［（54±11）% vs.（28±9）%，P＜0.01］，并可抑制细胞色素C的释放，减少Cleaved-Caspase 3的激活。结论 ROSC后吸入七氟醚，可减轻大脑皮层神经元凋亡，改善复苏后脑功能，其机制可能与调节Bcl-2/Bax表达有关。

体表针刺电刺激诱发心室纤颤猪模型的构建

目的构建一种经济、简便、安全又高效的心脏骤停(CA)猪模型。方法以12只西藏小型猪为研究对象。使用2根针灸针分别穿刺于心脏左右两侧,一根于胸骨右缘第四肋间与胸壁呈30°~60°夹角插入约3 cm,并调整针柄,直至针柄随心脏节律性跳动而心电图未出现室性早搏改变;另一根插入左侧腋下皮下组织约3 cm,以不损伤重要器官为宜。将2根针柄通过导线与3节串联9V干电池组连接,形成回路及直流电刺激。经皮电刺激3 s诱导心室颤动,以构建CA猪模型,记录模型构建成功率。经4 min非干预期后,根据Utstein模式标准对实验动物进行心肺复苏(CPR),并观察该模型复苏后生存情况。结果 12只西藏小型猪通过经皮电刺激诱导室颤,有11只致颤成功,成功率为91.67%(11/12)。动物模型经CPR后,5只实现自主循环恢复(ROSC),复苏成功率为45.45%(5/11)。在后续生存观察中发现:成功复苏的动物24 h存活率达100%(5/5),72 h存活率达80%(4/5)。经72 h观察后对成功复苏的西藏小型猪进行解剖,均未发现实验操作所致的胸腹部重要器官明显损伤。结论利用西藏小型猪,采用针灸针与干电池可以成功构建出相对稳定的CA模型。该模型构建方法具有经济、简便、安全及高效的优势。

成人先天性心脏病开胸过程突发室颤的原因分析及处理

目的 探讨成人先天性心脏病（ACHD）开胸过程突发室颤的原因、治疗策略及预防措施.方法 分析1992年以来我院5例ACHD患者开胸过程发生室颤的临床资料.结果 开胸过程发生室颤的5例患者经处理均恢复为术前心律,4例继续完成心内畸形矫治手术,1例放弃手术,术后死亡.结论 ACHD开胸过程突发室颤与长期心内异常分流导致心脏结构改变、心肌功能障碍有关,麻醉及开胸时手术刺激也有可能诱发.应立即进行胸内心脏按压以保证有效循环,尽可能早地进行胸内电除颤复律,根据复苏效果判断机体能否耐受继续手术.

心搏骤停患者入急诊抢救室时机与心室纤颤时间对除颤效果的影响

目的：了解心搏骤停患者入急诊抢救室的时间对复苏效果的影响和除颤与心肺复苏（CPR）先后顺序以及心室纤颤时间对除颤效果的影响。方法分析总结2011年1月~2014年12月期间工作时间和休息时间因心搏骤停进入急诊室抢救的162例患者,按心搏骤停发生至急诊抢救时间分为〈4 min组（82例）、4~10 min组（50例）、〉10 min组（30例）。每组患者再分为直接除颤组和先CPR再除颤组,分析比较不同室颤时间以及除颤、CPR先后顺序的除颤成功率。结果工作时间（日间）入抢救室的心搏骤停患者与休息时间（节假日及夜间）入抢救室的患者复苏率差异无统计学意义（P〉0.05）。随着室颤时间的延长,除颤的成功率明显下降。室颤时间〈4 min组、4~10 min组、〉10 min组除颤成功率分别为75.61%、56.00%、20.00%,室颤时间〉10 min组与〈4 min组、4~10 min组除颤成功率比较差异有统计学意义（P〈0.0167）。室颤时间〈4 min 组,先 CPR 再除颤组的除颤成功率与直接除颤组差异无统计学意义（77.50%比73.81%,P〉0.05）；室颤时间4~10 min组,先CPR再除颤组的除颤成功率明显高于直接除颤组（72.00%比40.00%, P〈0.05）；室颤时间〉10 min组,先CPR再除颤组的除颤成功率明显高于直接除颤组（40.00%比0,P 〈0.05）。结论心搏骤停的患者复苏成功率与在工作时间与休息时间入急诊抢救室的时机无明显关系,心搏骤停室颤持续时间是影响除颤效果的重要因素。

第50例:临床表现间断短暂意识丧失

患者男性，13岁，因“间断意识丧失2年”于2015年10月9日入院。患者2年前练习击鼓过程中突发意识丧失，伴呼吸心跳骤停、口吐白沫、小便失禁，立即心外按压，外院予以电除颤、气管插管、呼吸机等治疗后恢复，查心电图未见明显异常，未进一步诊治。入院前半个月于打球过程中再次出现意识丧失，伴心悸、四肢抽搐、口吐白沫，持续2 min 自行恢复，好转后除轻度稍头晕外无其他明显不适。

非体外循环心脏不停跳冠状动脉旁路移植同期室壁瘤切除对患者心功能的影响

目的探讨非体外循环心脏不停跳冠状动脉旁路移植(CABG)同期室壁瘤切除对患者心功能的影响。方法选取从2016年10月至2018年10月间于中国科学技术大学附属第一医院,住院接受非体外循环心脏不停跳冠状动脉(冠脉)旁路移植术同期室壁瘤切除术治疗的10例患者作为观察组。另取同期接受单纯非体外循环心脏不停跳冠脉旁路移植术治疗的10例患者作为对照组。比较两组患者在手术时间、术后呼吸机使用时间、ICU停留时间、住院时间以及两组患者手术前后心功能相关指标水平的差异。结果观察组患者手术时间、术后呼吸机使用时间、ICU停留时间、住院时间分别为(4.02±1.04)h、(18.02±1.42)h、(59.67±10.84)h、(11.74±0.85)d,与对照组的(4.33±1.01)h、(17.66±1.47)h、(60.32±10.72)h、(11.26±0.91)d相比均不明显,差异均无统计学意义(P均>0.05)。术后观察组患者左室射血分数(50.01±4.08)%较术前(46.04±4.22)%明显升高,而左室舒张末期容积水平(57.24±4.55)ml较手术前(61.42±3.29)ml明显降低,差异有统计学意义(P均<0.05)。结论非体外循环心脏不停跳下冠脉旁路移植同期室壁瘤切除有效改善患者的心功能,具有一定的临床推广价值。