[SCD-FORUM] 57S RE: 心脏呼吸停止和心脏猝死

[SCD Symposium]

57SRE:心脏呼吸停止和心脏猝死
来自墨西哥的Enrique Asensio L.医生回答：
从某种意义上来讲，心脏停止即标志着生命的终结。 
但我们知道，尽管在许多国家的法律规定脑死亡即意 
味着死亡，但这与心脏停跳或快速心律失常等原因所 
造成的低心输出量状态有着明显的界限。也有必要将 
室速/室颤与无脉、心脏暂停等死亡表象区分开来。 
但很多时候，这些异常电活动会一直持续下去，尽管 
我们采取了各种各样的干预手段，受治疗时机和治疗 
措施是否得当的影响，抢救成功率差异很大。

我个人认为，这种人为的划分实际意义并不大，因为 
实际工作中我们要考虑许多因素：可以把心跳停止看 
作是脉搏消失吗？然而，发生室速或室颤的很多情况 
下，尽管脉搏及其缓慢（心电图为逸搏心律或房室传 
导阻滞），为何我们仍旧开始心肺复苏呢？由于其相 
关的病理生理学概念繁多，且主要由于室速和室颤发 
生和转归的动态性，我们再次陷入了这些难以具体定 
义的术语的讨论中。不知各位专家还有何高见？
Enrique Asensio L.
México
刘莹译，王玲洁校

57S RE: Cardiorespiratory arrest and sudden cardiac death. Dr. Asensio
 From a certain point of view, cardiac arrest is the time of death,
although we all know there is a margin between brain death, legally
considered in many countries as "death" proper, and cardiac arrest or
else, tachyarrythmias that condition low output. It would be
necessary to differentiate also VT/VF from electrical activity with
no pulse, or asystole as cause of death. We know that on many
occasions, they are a continuum that we attempt to stop with
different interventions that are variably successful according to the
opportunity and efficacy.
 From my personal point of view, the difference may be more semantic
than practical, due to the great amount of variables to take into
account: do we consider cardiac arrest as the disappearance of pulse?
However, many times there is VT or VF, why can we start CPR even when
there are still slow pulses (escape rhythms or AV blocks in ECG)?
Again we are involved in a discussion of terms very hard to define
because of the number of pathophysiological concepts and mostly, due
to the " dynamics" of events and their sequences. What do experts think?

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee