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7例患者于麻醉期间发生循环骤停,其中3例脑复苏满意,另外4例因原发疾病严重而脑功能未恢复。作者讨论了脑复苏中的几个问题:①对脑水肿,作者主张采取降温、脱水、皮质激素治疗。②降温时间不宜短于3～4天,温度宜维持于32°～34℃。③使用高渗脱水药物降低颅内压,脱水的原则是增加出量,而不是限制入量,维持每天尿量大于1500ml。保持体液负平衡,直至临床脑水肿症状明显好转。④应用激素一般不长于72h;若出现脑水肿反复,减量使用可达10天。⑤复苏后即应在血气监测下管理好肺的换气和通气,P_aO_2≥13.3kPa,FiO_20.5,P_aCO40.0～4.6kPa,预防及治疗肺内感染。⑥处理过敏性休克的经验是采用大剂量皮质激素。⑦“三联”心内注射可能带来缺点,一般均以肾上腺素为首选,以静脉给药为佳。
Seven patients underwent circulatory arrest during anesthesia, three of whom were satisfied with cerebral resuscitation and the other four had no recovery of brain function due to severe primary disease. The authors discuss several issues in cerebral resuscitation: ① on cerebral edema, the authors advocate the use of cooling, dehydration, corticosteroids. ② cooling time should not be shorter than 3 to 4 days, the temperature should be maintained at 32 ° ~ 34 ℃. ③ The use of hypertonic dehydration drugs to reduce intracranial pressure, dehydration principle is to increase the amount, rather than limit the amount, to maintain daily urine output is greater than 1500ml. Maintain the body fluid negative balance until clinical symptoms of cerebral edema significantly improved. ④ hormone application is generally not longer than 72h; if repeated brain edema, reduced use up to 10 days. ⑤ after resuscitation should monitor the blood gas monitoring ventilation and ventilation of the lungs, P_aO_2 ≥ 13.3kPa, FiO_20.5, P_aCO40.0 ~ 4.6kPa, prevention and treatment of pulmonary infection. ⑥ experience in dealing with anaphylactic shock is the use of high-dose corticosteroids. ⑦ “triple” intracardiac injection may bring disadvantages, are generally preferred epinephrine, intravenous administration is better.