心搏骤停后的溶栓治疗_West China Medical Journal

Authors：

 唐艳 ¹ ,  王健 ²

1. ;
2. ;

Corresponding author：

王健, Email: 42523748@qq.com

Keywords：

心搏骤停; 脑复苏; 溶栓治疗

DOI：

10.7507/1002-0179.20150184

Video：

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心搏骤停是临床上常见的急症，病死率很高。任何原因导致的心搏骤停或其他急性事件引起的严重心肺损害发生后，由于脑组织失去系统循环及脑氧输送，将迅速导致不可逆性的缺氧-缺血性脑损伤，这也正是复苏后期患者死亡的主要原因。心肺复苏后，尽管存在足够的系统循环容量，但脑组织常发生微循环再灌注衰竭，使组织缺血延长，进而导致并加重继发性脑损伤，影响复苏治疗的远期预后。因此，心肺复苏成功的标志不仅仅是自主循环的恢复，其最终目的是保护并恢复完整的脑功能。溶栓治疗无论是对冠状动脉血栓形成或肺栓子的直接作用，还是对微循环再灌注的作用，均可能改善神经学后果，但由于惧怕严重出血并发症，溶栓治疗脑复苏长期被视为禁忌。现对心搏骤停后是否行溶栓治疗以及溶栓时机的选择等研究内容作一综述。

Citation： 唐艳, 王健. 心搏骤停后的溶栓治疗. West China Medical Journal, 2015, 30(4): 631-634. doi: 10.7507/1002-0179.20150184 Copy

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14.	Voipio V, Kuisma M, Alaspaa A, et al. Thrombolytic treatment of acute myocardial infarction after out-of-hospital cardiac arrest[J]. Resuscitation, 2001, 49(3):251-258.
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16.	Kurkciyan I, Meron G, Sterz F, et al. Major bleeding complications after cardiopulmonary resuscitation:impact of thrombolytic treatment[J]. J Intern Med, 2003, 253(2):128-135.
17.	Lederer W, Lichtenberger C, Pechlaner C, et al. Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest[J]. Resuscitation, 2001, 50(1):71-76.
18.	Lederer W, Lichtenberger C, Pechlaner C, et al. Long-term survival and neurological outcome of patients who received recombinant tissue plasminogen activator during out-of-hospital cardiac arrest[J]. Resuscitation, 2004, 61(2):123-129.
19.	Li X, Fu QL, Jing XL, et al. A meta-analysis of cardiopulmonary resuscitation with and without the administration of thrombolytic agents[J]. Resuscitation, 2006, 70(1):31-36.
20.	Renard A, Verret C, Jost D, et al. Impact of fibrinolysis on immediate prognosis of patients with out-of-hospital cardiac arrest[J]. J Thromb Thrombolysis, 2011, 32(4):405-409.
21.	Perrott J, Henneberry RJ, Zed PJ. Thrombolytics for cardiac arrest:case report and systematic review of controlled trials[J]. Ann Pharmacother, 2010, 44(12):2007-2013.
22.	Böttiger BW, Bode C, Kern S, et al. Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation:a perspective clinical trial[J]. Lancet, 2001, 357(9268):1583-1585.
23.	Abu-Laban RB, Christenson JM, Innes GD, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity[J]. N Engl J Med, 2002, 346(20):1522-1528.
24.	Fatovich DM, Dobb GJ, Clugston RA. A pilot randomised trial of thrombolysis in cardiac arrest (The TICA trial)[J]. Resuscitation, 2004, 61(3):309-313.
25.	Bozeman WP, Kleiner DM, Ferguson KL. Empiric tenecteplase is associated with increased return of spontaneous circulation and short term survival in cardiac arrest patients unresponsive to standard interventions[J]. Resuscitation, 2006, 69(3):399-406.
26.	Böttiger BW, Arntz HR, Chamberlain DA, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest[J]. N Engl J Med, 2008, 359(25):2651-2662.
27.	Spöhr F, Böttiger BW. Safety of thrombolysis during cardiopulmonary resuscitation[J]. Drug Saf, 2003, 26(6):367-379.

1. Howard RS, Holmes PA, Koutroumanidis MA. Hypoxic-ischaemic brain injury[J]. Pract Neurol, 2011, 11(1):4-18.
2. Maca J, Kula R, Jahoda J, et al. Thrombolysis and cardiac arrest[J]. Bratisl Lek Listy, 2010, 111(11):619-624.
3. FischerM, Hossmann KA. Volume expansion during cardiopulmonary resuscitation reduces cerebral no-reflow[J]. Resuscitation, 1996, 32(3):227-240.
4. Böttiger BW, Schmitz B, Wiessner C, et al. Neuronal stress response and neuronal cell damage after cardiocirculatory arrest in rats[J]. J Cereb Blood Flow Metab, 1998, 18(10):1077-1087.
5. Bottiger BW, Motsch J, Braun V, et al. Marked activation of complement and leukocytes and an increase in the concentrations of soluble endothelial adhesion molecules during cardiopulmonary resuscitation and early reperfusion after cardiac arrest in humans[J]. Crit Care Med, 2002, 30(11):2473-2480.
6. Harper A, Coates L. Role of thrombolysis in resuscitation[J]. Lancet, 2001, 358(9290):1371.
7. Böttiger BW, Martin E. Thrombolytic therapy during cardiopulmonary resuscitation and the role of coagulation activation after cardiac arrest[J]. Curr Opin Crit Care, 2001, 7(3):176-183.
8. Wetsch WA, Spoehr F, Teschendorf P, et al. Thrombolysis during cardio-pulmonary resuscitation[J]. Deutsche Medizinische Wochenschrift, 2010, 135(40):1983-1988.
9. Logan JK, Pantle H, Huiras P, et al. Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism[J]. Am J Emerg Med, 2014, 32(7):789-796.
10. Tranberg T, Vagner NJ, Christensen A, et al. Acute pulmonary embolism and cardiac arrest treated with thrombolysis and an automatic chest compression device[J]. Ugeskr Laeger, 2013, 175(36):2043-2044.
11. Gupta R, Jindal A, Cranston-D'amato H. Benefits of thrombolytics in prolonged cardiac arrest and hypothermia over its bleeding risk[J]. Int J Crit Illn Inj Sci, 2014, 4(1):88-90.
12. Spöhr F, Böttiger BW. Thrombolytic therapy during or after cardiopulmonary resuscitation. Efficacy and safety of a new therapeutic approach[J]. Minerva Anestesiol, 2003, 69(5):357-364.
13. Ruiz-Bailen M, De Hoyos EA, Serrano-Corcoles MA, et al. Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation[J]. Intensive Care Med, 2001, 27(6):1050-1057.
14. Voipio V, Kuisma M, Alaspaa A, et al. Thrombolytic treatment of acute myocardial infarction after out-of-hospital cardiac arrest[J]. Resuscitation, 2001, 49(3):251-258.
15. Schreiber W, Gabriel D, Sterz F, et al. Thrombolytic therapy after cardiac arrest and its effect on neurological outcome[J]. Resuscitation, 2002, 52(1):63-69.
16. Kurkciyan I, Meron G, Sterz F, et al. Major bleeding complications after cardiopulmonary resuscitation:impact of thrombolytic treatment[J]. J Intern Med, 2003, 253(2):128-135.
17. Lederer W, Lichtenberger C, Pechlaner C, et al. Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest[J]. Resuscitation, 2001, 50(1):71-76.
18. Lederer W, Lichtenberger C, Pechlaner C, et al. Long-term survival and neurological outcome of patients who received recombinant tissue plasminogen activator during out-of-hospital cardiac arrest[J]. Resuscitation, 2004, 61(2):123-129.
19. Li X, Fu QL, Jing XL, et al. A meta-analysis of cardiopulmonary resuscitation with and without the administration of thrombolytic agents[J]. Resuscitation, 2006, 70(1):31-36.
20. Renard A, Verret C, Jost D, et al. Impact of fibrinolysis on immediate prognosis of patients with out-of-hospital cardiac arrest[J]. J Thromb Thrombolysis, 2011, 32(4):405-409.
21. Perrott J, Henneberry RJ, Zed PJ. Thrombolytics for cardiac arrest:case report and systematic review of controlled trials[J]. Ann Pharmacother, 2010, 44(12):2007-2013.
22. Böttiger BW, Bode C, Kern S, et al. Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation:a perspective clinical trial[J]. Lancet, 2001, 357(9268):1583-1585.
23. Abu-Laban RB, Christenson JM, Innes GD, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity[J]. N Engl J Med, 2002, 346(20):1522-1528.
24. Fatovich DM, Dobb GJ, Clugston RA. A pilot randomised trial of thrombolysis in cardiac arrest (The TICA trial)[J]. Resuscitation, 2004, 61(3):309-313.
25. Bozeman WP, Kleiner DM, Ferguson KL. Empiric tenecteplase is associated with increased return of spontaneous circulation and short term survival in cardiac arrest patients unresponsive to standard interventions[J]. Resuscitation, 2006, 69(3):399-406.
26. Böttiger BW, Arntz HR, Chamberlain DA, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest[J]. N Engl J Med, 2008, 359(25):2651-2662.
27. Spöhr F, Böttiger BW. Safety of thrombolysis during cardiopulmonary resuscitation[J]. Drug Saf, 2003, 26(6):367-379.

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心搏骤停后的溶栓治疗

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