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目前认为,脑复苏的关键莫过于早期脑保护。当前最具意义的心肺复苏后脑保护措施包括:(1)药物治疗。硫喷妥钠降低新陈代谢,减轻脑水肿,降低颅内压,抑制癫痫发作,减轻缺血性脑损害。联合使用安定和镁制剂,能抑制神经兴奋,但对预后的影响尚无定论。(2)低温治疗。研究显示,心搏骤停后低温治疗有助于提高存活率并改善预后。其机制可能与延缓起初ATP的消耗;减少兴奋性神经递质释放;影响细胞内信使的活性;控制血脑屏障的破坏程度;减轻炎症反应;改变基因表达和蛋白合成;降低细胞内钙离子浓度;影响谷氨酸受体调节等有关。具体的降温和维持低温的方法有体表降温法、血流降温法和联合降温法。最近的研究证明,快速输注低温液体加体表冰毯诱导降温,然后用电冰毯维持效果良好。低温治疗应该尽早实施,复苏后4～6h深部体温要达到32℃～34℃的标准。一般持续24h左右。复温要缓慢,防止加重脑损害。要严格控制寒颤等并发症。本文还就其他脑保护措施,如维持良好的脑灌注、减轻脑水肿、降低颅内压、严格控制发热、高血糖和癫痫、抽搐等进行了叙述。大脑损害是心搏骤停后患者残疾的主要原因。救治这些患者需要采取多项脑保护措施进行综合治疗。在诸多方法中,低温治疗为心搏骤停的脑保护提供了一项安全而有效的手段。
At present, the key to brain recovery is early brain protection. The most significant post-CPR brain protection measures include: (1) drug treatment. Thiopentan sodium to reduce metabolism, reduce brain edema, reduce intracranial pressure, inhibit seizures, reduce ischemic brain damage. Joint use of stability and magnesium preparations, can inhibit nerve excitement, but the impact of prognosis is not conclusive. (2) Cryotherapy. Studies have shown that hypothermia after cardiac arrest helps to improve survival and improve prognosis. Its mechanism may delay the initial consumption of ATP; reduce excitatory neurotransmitter release; affect the activity of intracellular messengers; control the destruction of the blood-brain barrier; reduce the inflammatory response; alter gene expression and protein synthesis; reduce intracellular calcium concentration ; Affect glutamate receptor regulation and so on. Specific cooling and maintain low temperature body surface cooling method, blood cooling method and the joint cooling method. Recent studies have shown that rapid infusion of cryogenic liquid plus body surface ice blanket induced cooling, and then use electric ice cream to maintain good effect. Cryotherapy should be implemented as soon as possible, 4 ~ 6h after recovery deep body temperature to reach 32 ℃ ~ 34 ℃ standard. Generally lasts around 24h. Rewarming should be slow to prevent aggravating brain damage. To strictly control complications such as chills. This article also describes other brain protection measures, such as maintaining good cerebral perfusion, reducing cerebral edema, reducing intracranial pressure, controlling fever, hyperglycemia and epilepsy, convulsions and so on. Brain damage is the major cause of disability in patients after cardiac arrest. Treatment of these patients need to take multiple brain protection measures for comprehensive treatment. In many ways, hypothermia provides a safe and effective means of protecting the brain from cardiac arrest.