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題名 | Sudden Cardiac Death:Report of Nine Cases and the Impact of Early Primary Success on Outcome=心因性猝死:九個病例經驗報告--早期急救成功對於癒後之影響 |
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作者 | 林廷燦; 陳志中; 張朝煜; 郭憲文; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 13:4 民86.10-12 |
頁次 | 頁190-198 |
分類號 | 415.31 |
關鍵詞 | 猝死; 心室顫動; 初步成功; Sudden cardiac death(SCD); Ventricular fibrillation(VF); Primary success; |
語文 | 英文(English) |
中文摘要 | 簡介:猝死是急診重要的課題之一,大部份乃肇因於心室顫動。由於心肺復甦 術暨高級救命術之一進展及研究,早期電擊是很重要的一環。 方法與結果:我們報導了9例病例。為了了解心室顫動發作之自然病史,我們 將報導他們的最初臨床表徵、事故發生地點、運送系統以及病人癒後做一全盤 探討。本報告總計有9位病人。初步成功定義為經高級救命術(包含心肺甦術) 能恢復自發循環與竇性心率超過1小時者為限。反之視為失敗。9位病例當 中,男性居多高達7位。年齡從17歲至71歲不等,平均年齡為51歲。在我們 小系列裡,初步成功率可達67%。很幸運地有4位(44%)出著出院。若以最終 癒後而論,更早期接受高級救命術治療,早期初步成功,心電圖監視呈現精糙 性心室顫動者,無合併任何心衰竭或器官衰竭者。因此,早期初步成功無合併 症將是活著出院之良好指標。以上這些主要因子將是長期存活之關鍵因素。其 統計深具意義,另外加重因子以及生活各層面之調適也是良好長期癒後之保 證。 結論;早期成功是良好長期癒後之指標,總之,早期心肺復甦術及高級救命術 伴有早共電擊仍是急救活命之良方。良好的團隊合作及適切的內外科診療以及 各種因子之調適乃是長期癒後之不二法門。或許我們的經驗對此猝死病人會有 所幫忙。 |
英文摘要 | Background. Sudden cardiac death (SCD) is one of the most important conditions faced in emergency practice (EP). The majority of SCD are thought to be precipitated by ventricular fibrillation (VF). The most important issues are early defibrillation and cardiopulmonary resuscitation (CPR). Early primary success impact on long-term outcome has not been described before in EP especially in Taiwan. Methods and Results. Herein, the entire scenario of each of nine cases seen in an Emergency Department (ED) is presented. To define the natural history of SCD, initial presentation, primary event spot and transportation system, and underlying etiologies including pre-hospital care and emergency procedures are all described. Initial clinical characteristics, occupational and social background and precipitation or aggravation factors, as well as timing issues and final outcomes, are also provided. Primary success was defined as the return of spontaneous circulation and sinus rhythm for at least one hour duration post advanced cardiac life support (ACLS) procedures and active accessory support. In this small series of SCD, male patients were predominant, including seven of nine. The age distribution was from 17 to 71 years old, with a mean age of 51. Primary success was achieved up to 67% (6/9). Fortunately, four patients (44%) survived to discharge. In terms of final outcome, early access for advanced cardiac life support (ACLS), early primary success, ECG monitoring showing coarse VF and the absence of organ system failure seemed to play key roles between survivors and non-survivors (p<0.05). Conclusions. Early primary success was the key predictor for long-term survival. Early CPR and ACLS together with early defibrillation were strongly linked to the achievement of early primary success. Excellent emergency accessory support with prompt interventions in the ED are clearly needed to achieve final hospital discharge. Experience here may provide helpful information in this regard. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。