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恢复跳动:顽固性室颤的新策略
原作者: Benjamin Lawner,肖锋译 发布日期:2013-04-15

Title: Keeping the Beat: Strategies in Shock Refractory VF
题目:恢复跳动:顽固性室颤的新策略
Author 作者: Benjamin Lawner

Recent advances in resuscitation science have enabled emergency physicians to identify factors associated with good neurologic and survival outcomes. Cases of persistent ventricular dysrhythmia (VF or VT) present a particular challenge to the critical care provider. The evidence base for interventions in shock refractory ventricular VF mainly consists of case reports and retrospective trials, but such interventions may be worth considering in these difficult resuscitation situations:
复苏学的最新进展,已经能够使急诊医师明确判断具有良好的神经和生存恢复的因素。持续性的心室节律紊乱(室颤或室速)对于(急诊)危重病医生是一个特别的挑战。对电击顽固性室颤干预措施的循证基础主要来源于包括病例报告和回顾性试验,但在复杂的复苏情况下,这些方法还是值得考虑的:
1. Double sequential defibrillation
-For shock-refractory VF, 2 sets of pads are placed (anterior/posterior and on the anterior chest wall). Shocks are delivered as "closely as possible."1,2


双连续除颤-对于电击顽固性室颤,放置2套除颤垫(前/后和前胸壁)。两次电击除颤越近越好。1,2
2. Sympathetic blockade in prolonged VF arrest
-"Eletrical storm," or incessant v-fib, can complicate some arrests in the setting of VF. An esmolol bolus and infusion may be associated with improved survival.3  Left stellate ganglion blockade has been identified as a potential treatment for medication resistant VF.4
交感神经阻滞治疗延长的室颤骤停- “电流风暴”,或持续性室颤,增加了一些由室颤造成的心脏骤停的复杂程度。 艾司洛尔注射和点滴可能会改善生存率。3 左侧星状神经节阻滞已被认为是对药物治疗无效室颤的一个潜在的治疗手段。4
3. Don't forget about magnesium! 
-May terminate VF due to a prolonged QT interval.
不要忘记镁-可能会终断由QT间期延长导致的室颤。
4. Invasive strategies
-Though resource intensive, there is limited experience with intra-arrest PCI and extracorporeal membrane oxygenation. Preestablished protocols are key to selecting patients who may benefit from intra-arrest PCI and/or ECMO. 5
侵入性治疗-虽然有丰富的资料,但对于骤停时进行经皮冠状动脉介入治疗和体外膜肺氧合的临床经验有限。预先设定治疗方案是选择可能受益于经皮冠状动脉介入治疗和/或体外膜肺氧合病人的关键。5
5. Utilization of mechanical CPR devices 
-Though mechanical CPR devices were not officially endorsed by the AHA/ECC 2010 guidelines, there's little question that mechanical compression devices address the complication of provider fatigue during ongoing resuscitation. 
 利用机械CPR装置-机械CPR设备虽然没有正式通过2010年AHA / ECC的认可,但有一点是没有疑问的,既机械按压设备解决了在持续复苏中医护人员疲劳的问题。
References 参考文献:
1. EMS World Magazine online. "Hold the coroner!" 2011. Available at: 
http://www.emsworld.com/article/10318805/hold-the-coroner
2.  Hoch DH, Batsford WP, Greenberg SM, et al. Double sequential shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994;23(5):1141-5
3. de Oliveira FC, Feitosa-Filho GS, Ritt LE. Use of beta blockers for the treatment of cardiac arrest due to ventricular fibrillation/pulseless ventricular tachycardia: a systematic review. Resuscitation. 2012;83(6):674-83
4. Patel RA, Priore DL, Szeto WY, et al, Left stellate ganglion blockade for the management of drug-resistant electrical storm. Pain medicine. 2011;12:1196-1198.
5. Kagawa E, Dote K, Sasaki S, et al. Should we emergently revascularize occluded coronaries for cardiac arrest? rapid response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation. 2011;126(13):1605-13.