2015年AHA心肺复苏及心血管疾病指南设计更新要点.pdf

word 文档2015 年 AHA心肺复苏与心血管疾病指南更新要点10 月 15 日，美国心脏协会AHA 发布了 2015 版心肺复苏与心血管急救指南更新 以下简称指南更新 ，2015指南更新是基于国际证据评估流程，由来自39 个国家的 250 位证据审查专家共同参与完成。指南更新要点如下：新 AHA 建议级别和证据水平分级体系2015指南更新中使用的建议级别和证据水平，均依据 AHA的最新定义。最新版定义中的3 级建议有所更改，3 级：无益，当证据显示，有高质量或中等质量研究证据水平LOE分别为 A 或 B明确某项策略的效果并不优于对照组时，不常使用。证据水平也有所更改。LOE B 现分为 LOE B-R随机研究和 LOE B-NR 非随机研究。LOE C 现分为 LOE C-LD有限数据和 C-EO专家意见。总的来说，复苏学的证据水平和建议级别都较低，2015 版的所有建议中仅 1%315条建议中有 3 条基于最高证据水平LOE A，仅 25%的建议 315 条建议中 78 条word 文档被认定为 1 级强建议。2015指南更新中的大局部建议69%都只有最低证据水平的支持 LOE C-LD 或 C-EO ，将近一半 315 条建议中有 144 条，45%被定为 2 级弱建议。急救系统和持续质量改良2015 指南更新为利益相关方提供了一个审视救治体系的新视角，区分了院内心脏骤停IHCA和院外心脏骤停OHCA 。要点包括?救治体系通用分类?将 AHA成人生存链分为两链：一链为院内救治体系，另一链为院外救治体系?检视有关心脏骤停救治体系的最优证据的评估，集中在心脏骤停、ST段抬高型心肌梗死STEMI 和卒中问题上。非专业施救者心肺复苏2015指南更新建议中，有关非专业施救者实施成人心肺复苏的关键问题和重大变更包括如下内容：?院外成人生存链的关键环节和2010 年一样，继续强调简化后的通用成人根底生命支持BLS 流程。?成人根底生命支持流程有所改变，反映了施救者可以在不离开患者身边的情况下启动紧急反响即通过手机的现实情况。?建议在有心脏骤停风险人群的社区执行公共场所除颤PAD 方案。?鼓励迅速识别无反响情况，启动紧急反响系统，与鼓励非专业施救者在发现患者没有反响且没有呼吸或呼吸不正常如喘息时开始心肺复苏的建议得到强化。?进一步强调了调度人员需快速识别可能的心脏骤停，并立即向呼叫者提供心肺复苏指导即调度员指导下的心肺复苏。?确定了单一施救者的施救文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7word 文档顺序的建议：单一施救者应先开始胸外按压再进展人工呼吸C-A-B 而非 A-B-C，以减少首次按压的时间延迟。单一施救者开始心肺复苏时应进展30 次胸外按压后做2 次人工呼吸。?继续强调了高质量心肺复苏的特点：以足够的速率和幅度进展按压，保证每次按压后胸廓完全回弹，尽可能减少按压中断并防止过度通气。?建议的胸外按压速率是100 至 120 次/分钟此前为 至少100 次/分钟。?建议的成人胸外按压幅度是至少2 英寸 5 厘米，但不超过2.4 英寸6 厘米。?如果有疑似危与生命的、与阿片类药物相关的紧急情况，可以考虑由旁观者给予纳洛酮。医护人员 BLS在 2015指南更新中，针对医务人员的关键问题与重大变更如下：?这些建议使得应急反响系统的启动更加灵活，更加符合医护人员的临床环境。?鼓励经过培训的施救者同时进展几个步骤即同时检查呼吸和脉搏，以缩短开始首次胸部按压的时间。?由多名经过训练有素的施救者组成的综合小组可以采用一套精心设计的方法，同时完成多个步骤和评估，而不用如单一施救者那样依次完成例如由 1 名施救者启动急救反响系统，第2 名施救者开始胸外按压，第3 名进展通气或者取得球囊面罩进展人工呼吸，第4 名取回并设置好除颤器。?运用绩效指标，进一步强调了高质量心肺复苏包括以足够的速率和深度进展按压，保证每次按压后胸廓回弹，尽可能减少按压中断，并防止过度通气。见表1。?按压速率改为每分钟100 至 120 次。?按压成人深度改为至少2 英寸 5 厘米而不超过 2.4 英寸 6 厘米。?为使每次按压后胸廓充分回弹，施救者必须防止在按压间隙倚靠在患者胸上。?判断减少按压中断的标准是以胸外按压在整体心肺复苏中占的比例确定的，所占比例越高越好，目标比例为至少60%。?如果紧急医疗系统采用包括持续胸部按压的综合救治干预，对于院外心脏骤停患者可以考虑在综合救治干预中使用被动通气技术。?对于正在进展持续心肺复苏且有高级气道的患者，对通气速率的建议简化为每6 秒一次呼吸每分钟10 次呼吸。心肺复苏的替代技术和辅助装置传统心肺复苏包括人工胸外按压配合人工呼吸。从产生明显心输出量的角度来说，这存在固有的低效的一面。已研究出传统心肺复苏的一系列替代方法和辅助手段，以便在对心脏骤停实施复苏的过程中增强心输出量。2010 版指南出版以来，已有很多临床试验给这些替代方法的有效性提供了文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7word 文档新数据。与传统心肺复苏相比，这些技术和装置多需要特殊的设备和培训。当施救者或医疗系统考虑实施这些手段时，必须注意，有些技术和装置仅在精心选择的心脏骤停患者亚组中试验过。?不建议例行使用阻力阀装置ITD辅助传统心肺复苏。?最近的一项随机对照试验明确，使用阻力阀装置搭配主动按压减压心肺复苏，可以增加院外心脏骤停患者神经功能完好的存活率。?不建议机械胸外按压装置的常规使用，但也已确认，特殊情况下这项技术可能有用。?假如怀疑由可逆因素导致心脏骤停，可以考虑对选定的患者使用体外心肺复苏。文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7word 文档成人高级心血管生命支持2015指南更新建议中有关高级心脏生命支持的关文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7word 文档键问题和重大变更包括如下内容：?联合使用加压素和肾上腺素，相比使用标准剂量的肾上腺素在治疗心脏骤停时没有优势。而且，给予加压素相对仅使用肾上腺素也没有优势。因此，为了简化流程，已从成人心脏骤停流程中去除加压素-2015 更新。?经过 20 分钟心肺复苏后，呼气末二氧化碳ETCO2仍然较低的插管患者复苏的可能性很低。尽管不能单凭此项指标进展决策，但医护人员可以把20 分钟心肺复苏后低 ETCO2与其他因素综合考虑，帮助确定终止心肺复苏的时间。?类固醇和加压素与肾上腺素一起做综合干预，治疗院内心脏骤停可能有益。尽管不建议在以后的随访研究中常规使用此综合治疗，但医护人员在治疗院内心脏骤停时仍然可以使用。?ECPR 快速实施时，可以延长可用性，因为可以争取时间治疗潜在的可逆病症，或为传统 CPR 未能复苏的患者安排心脏移植。?对于心律不可电击，转而承受肾上腺素治疗的心脏骤停患者，建议尽早使用肾上腺素。?有关 ROSC 后使用利多卡因的研究存在矛盾，不建议常规使用利多卡因。但是室颤/无脉性室性心动过速pVT导致心脏骤停，在出现ROSC 后，可以考虑立即开始或继续施用利多卡因。?一项观察性研究明确，心脏骤停后使用-受体阻滞剂可能会比不用-受体阻滞剂效果更好。尽管这项观察性研究还不足以成为将其建议为常规疗法的有力证据，但因室颤/无脉性室性心动过速导致心脏骤停而入院后，可以考虑尽早开始或继续口服或静脉注射-受体阻滞剂。心脏骤停后救治2015指南更新 中有关心脏骤停后救治建议的关键问题和重大变更包括如下内容：?对于所有 ST段抬高的患者，以与无 ST段抬高，但血流动力学或心电不稳定，疑似心血管病变的患者，建议紧急冠状动脉血管造影。?有关目标温度管理的建议有所更新。新的证据明确，一定 X围内的温度都可作为心脏骤停后一定时间段内的目标温度。?TTM 目标温度管理完毕后，可能会出现发热症状。尽管有关TTM 目标温度管理完毕后发热危害的观察性证据存在矛盾，但仍然认为预防发热是有益的，因此应该预防。?在复苏后，建议立即确认并矫正低血压症状。?现在建议必须在TTM 目标温度管理完毕72 小时后才能做预后评估；对于未采用TTM的患者，应当在恢复自主循环72 小时后做预后评估。?所有初次心脏骤停后开展为脑死亡或循环死亡的患者都应视为可能的器官捐献者。急性冠脉综合征2015指南更新中，AHA对 ACS的评估和管理指南局部有变更。自本次更新起，建议将仅限于入院前和急诊科阶段的护理。院内护理的内容见AHA和美国心脏病学会基金会联合发表的心肌梗死管理指南。在 2015指南更新中，针对 ACS的建议中关键问题与重大变更如下：?入院前心电图获取与解读?假如院前能够进展溶栓治疗，再灌注策略的选择?假如在不能进展PCI 的医院，再灌注策略的选择?利用肌钙蛋白确定能安全离开急诊科的患者?到达医院实施但不一定有利的干预措施特殊复苏环境?治疗或疑似阿片类药物过量患者的经验明确，急救和BLS中给予纳洛酮似乎是安全有效的。因此，现在建议非专业施救者和医护人员给予纳洛酮，并提供了简化的培训方法。另外，提供了一份新的、针对疑似阿片类药物过量的无反响患者的处理流程图。?可考虑用静脉脂肪乳剂ILE治疗局部麻醉剂全身中毒。此外还提供了一条新的建议，支持对发生心脏骤停，却由于除局部麻醉剂全身中毒以外的其他药物中毒导致标准复苏措施失败的患者施用ILE。?任何心脏骤停中，高质量 CPR都是非常重要的，因此重新评估了孕期发生心脏骤停时减轻主动脉下腔静脉压力的建议。此次重新评估得出了对子宫移位策略的优化建议。儿童根底生命支持和心肺复苏质量儿童 BLS中的变更和成人BLS的变更一致。审查的问题包括以下内容：?重申了 C-A-B 为儿童 CPR 的优先程序?手机时代单一施救者和多施救者的医护人员儿童CPR新流程?确定了青少年胸部按压深度6 厘米的上限?同成人 BLS，文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7文档编码:CJ4S7V2J4V5 HY4S5Z3G4G8 ZU1V6H9V9P7word 文档建议的胸外按压速率是100 到 120 次每分钟?着重重申了儿童BLS需要按压和通气 儿童高级生命支持儿童高级生命支持的文献审查中涉与的多个关键问题，对现有建议进展了优化而没有提出新建议。在很多问题上提供了新的信息或更新，包括发热病症时的液体复苏，气管插管前给予阿托品，对电击难以纠正的室颤/无脉性室性心动过速使用胺碘酮和利多卡因，婴儿和儿童心脏骤停复苏后的目标温度管理，心脏骤停后的血压管理。?在特定条件下，治疗有发热病症的儿童患者时，使用限制量的等渗晶体液可以增加存活率。这与常规的大量液体复苏有益的传统想法相反。?对非新生儿急诊气管插管时常规给予阿托品作为术前用药，专门预防心律失常的做法存在争议。而且，有证据显示，为此目的给予阿托品不存在最小用量的要求。?如果有创动脉血压监控已经就位，如此可以用其调整心肺复苏，以使心脏骤停的儿童达到特定的血压目标。?对于儿童患者，电击难以纠正的室颤和无脉性室性心动过速，可用胺碘酮或利多卡因作为抗心律失常药物。?肾上腺素仍被建议为儿童心脏骤停时的血管加压药。?对于在实行现有的体外膜肺氧合操作规X 的机构中发生院内心脏骤停，诊断有心脏病症的儿童患者，可以考虑 ECPR。?救治 OHCA 后恢复自主循环的昏迷的儿童时，应防止发热。一项针对 OHCA儿童低温治疗的大型随机试验明确，无论是一段时间的中度低温治疗温度维持在32 到 34 ，还是严格维持正常体温 温度维持在 36 到 37.5 ，结果没有区别。?预后的意义需检测几项骤停中和骤停后的临床变量。没有发现有哪一项单一的变量足以可靠地预测结果。因此，救治者在心脏骤停中和恢复自主循环后预测结果时应该考虑多种因素。?自主循环恢复以后，应该使用液体和血管活性药物输注，使收缩压维持在患者年龄段的第5 百分位以上。?自主循环恢复以后，应以正常血氧水平为目标。如果有必须的装置，应逐步减低氧的供给，使氧合血红蛋白饱和度达到 94%到 99%。应严格防止低氧血症。理想情况下，准确调整氧供到一个适宜的值以适合患者的具体情况。同样，自主循环恢复后，儿童的PaCO2也应根据每个患者的情况，确定一个适宜的目标水平。应防止出现严重的高碳酸血症或低碳酸血症。新生儿复苏新生儿的心脏骤停绝大局部是窒息性的，因此开始通气仍然是最初心肺复苏时的重点。2015 版中主要的新生儿主题如下：?3 个评估问题的顺序变为 1足月妊娠？2X 力良好？3呼吸或啼哭？?黄金一分钟 60 秒的说法仍然保存。在这一分钟内要完成初始步骤、再评估、如有需要开始通气。这强调了开始通气时防止不必要的延误的重要性，因为当新生儿未能对初始步骤产生反响时，通气是心肺复苏能成功的最重要步骤。?有一条新建议，对于足月新生儿或出生时无需复苏的早产儿，都把脐带结扎延迟30 秒以上。但对于出生时需要复苏的新生儿的脐带结扎方法，尚没有足够的证据能给出建议。有建议反对把脐带压法非研究环境下作为对不足 29 周妊娠婴儿的常规做法，除非了解到有更多的益处和并发症才可使用。?应该记录温度，作为结果预测指标和质量指标。?无窒息的新生儿出生后温度应维持在36.5 至 37.5。?采用各种不同的策略 热辐射器、塑料做帽子某某、保温毯、温暖的湿气、升高房间温度并用帽子和保温毯防止早产儿体温过低是合理的。应防止体温过高温度高于38 ，因为可能带来风险。?在资源有限的条件下，在刚出生的最初几小时内采用简单的措施防止体温过低使用塑料包裹、皮肤接