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本文介绍了连续三例严重低温意外的病人经快速中心复温而完全恢复的经验。三例病人入院时均属临床死亡,表现为对刺激无反应、呼吸停止、肢体瘫软和瞳孔散大固定。2例室颤,1例心跳停止。直肠温度19—24℃不等。例1,41岁,因雪崩而埋于数尺深的雪中2.5小时。遇救时呼吸已停止,心脏已停搏。在现场作气管插管后,立即用直升飞机送往医院,途中一直进行人工呼吸心外按摩。入院后肛温22℃ EKG 呈室颤。开胸后用温水27升/小时连续灌洗心周间隙及用温盐水洗胃。90分钟时体温升到26℃,除颤成功。术后病程稳定,2周后痊愈出院。例2,42岁,因雪崩被埋入7米深的冰雪中5小时。遇救时呼吸心跳停止。肛温19℃。遇救后70分钟决定并进行了气管插管人工呼吸和胸外按压。遇救后3小时经股动,静脉用体外循环机心肺转流心脏快速复温。同时进行胸骨中线切开术,发现心脏处于如石头般的收缩状态,直接按压无效。在体外循环每分钟流量2.5～3升的速度下使平均动脉压保持在50mmHg。20分钟后复温到36℃,心脏逐渐柔软。30分钟时电除颤成功。术后有肺水肿。后痊愈出院。
This article describes the experience of three consecutive patients with severe hypothermia who were fully recovered by rapid central rewarming. All three patients were clinically dead at admission and showed no response to stimulation, cessation of breathing, paralysis of the limbs and fixation of mydriasis. 2 cases of ventricular fibrillation, 1 case of cardiac arrest. Rectal temperature ranging from 19-24 ℃. Example 1,41 years old, buried in snow in a few feet due to avalanches 2.5 hours. Rescued breathing has stopped, the heart has been stopped. After the endotracheal intubation at the scene, immediately sent by helicopter to the hospital, on the way has been carried out artificial respiration cardio massage. After admission, rectal temperature 22 ℃ EKG was ventricular fibrillation. Thoracotomy with warm water 27 liters / hour continuous perfusion peritoneal space and gastric lavage with warm saline. 90 minutes when the body temperature rose to 26 ° C, defibrillation success. Stable course of surgery after 2 weeks cured. Example 2,42 years old, due to avalanches buried in 7 meters of ice and snow for 5 hours. Rescue heartbeat stopped. Rectal temperature 19 ℃. 70 minutes after the rescue decision and carried out endotracheal artificial respiration and chest compression. 3 hours after the rescue by the stock move, intravenous cardiopulmonary bypass cardiopulmonary bypass heart rapid rewarming. Simultaneous sternal midline incision, found that the heart is in a stone-like contraction, direct pressure is invalid. Mean arterial pressure was maintained at 50 mm Hg at a flow rate of 2.5 to 3 liters per minute of cardiopulmonary bypass. After 20 minutes rewarmed to 36 ℃, the heart gradually soft. Electric defibrillation succeeded 30 minutes. Postoperative pulmonary edema. After healed and discharged.