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題 名 | 以臨床實用觀點論急救流程之改變=The New Changes of Advanced Cardiac Life Support Algorithms--From the Clinical and Practical Points of View |
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作 者 | 林世崇; 蔡米山; 郭美娟; 楊惠琳; 謝凱生; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 3:3 2001.07[民90.07] |
頁 次 | 頁256-264 |
專 輯 | 心臟專題 |
分類號 | 415.22 |
關鍵詞 | 高階心臟急救術; 急救流程圖; 心室纖維顫動; 急性冠心症; Advanced cardiac life support; ACLS; Resuscitation algorithms; Ventricular fibrillation; VF; Acute coronary syndromes; |
語 文 | 中文(Chinese) |
中文摘要 | 高階心臟急救術(Advanced Cardiac Life Support,ACLS),從1986年的4個急救流程圖(Algorithm),到目前已增加為18個。2000年緊急心臟照護準則,是基於實證醫學(Evidence based medicine)之急救知識,並經多數專家及多次會議而得到的共識。流程圖的結構包括原有的由上而下分類思考之模式外,另外增加了“觀察(Observation)”及“行動(Action)”的附帶說明,以方框(Box)註明。除了加強再次(Secondary)ABCD之思考更為周詳外,最明顯的急救流程圖改變包括,心室纖維顫動(VF),心博過速的治療改變,及對於非ST-T上升的急性心肌梗塞,包括無Q波梗塞(Non-Q MI)及高危險度之不穩定狹心症,使用醣蛋白抑制劑之治療。新的心博過速治療流程圖雖然較1997年版更為詳細,但實際效用及教學效果則仍有待觀察及探討。以Amiodarone為例,靜脈推注時,需要較大之血管徑路,而在急救時,血管穿刺技術較為困難;且需要10分鐘慢速滴注,在這漫長的10分鐘裡,新的治療流程圖並未詳細說明應採取如何的緊急處置。學員亦因此而感到困惑。簡單的急救治療流程圖有益於學習,但對於複雜的臨床狀況卻很難顧及。相反的,詳細而複雜的急救治療流程圖,有助於臨床狀況的周密思考及判斷,但對於一般的學員在學習過程中,則需要付出更多的努力。無論急救方式如何改變,病人之生命仍然視為第一優先。 |
英文摘要 | Based on the evidence-based approach, the algorithms of Advanced Cardiac Life Support (ACLS) have increased from previous cardiac arrest 4 algorithms to the present 18. The main new changes included the stress on the ABCD survey of the patients, ventricular fibrillation, management of tachyarrhythmias, and acute coronary syndromes. Amiodarone and vasopressin are included in the algorithms instead of lidocaine treatment for the priority and drug effects. During the slow infusion of Amiodarone used in ventricular fibrillation, the detailed resuscitation procedures are not clarified and confuses the health givers and providers in the ACLS class. The most complicated changes of the new algorithms are the parts of tachyarrhythmias, which include clinical judgment, and electrocardiographic classification. It is difficult to evaluate the patient’s left ventricular performance on emergency condition of victims of tachyarrhythmia, especially when there is no previous data available for comparison. The complexity of the algorithms makes the ACLS protocol more realistic to the clinical situation. However, for the health givers and providers in learning, this detailed and complicated resuscitation algorithms may impact the education and learning feedback form the ACLS class. Although updated medical sill and knowledge are helpful for resuscitating the patients, but the patient himself is still the first priority we have to take into consideration. |
本系統中英文摘要資訊取自各篇刊載內容。