心肺复苏后脑保护的护理核心策略与思考

doi:10.3761/j.issn.2096-7446.2025.07.004

Abstract

Abstract:

Brain protection after cardiopulmonary resuscitation（CPR） is a key intervention strategy to improve the prognosis of neurological function of patients，but its clinical nursing practice still faces the challenge of insufficient standardization. By systematically reviewing domestic and foreign guidelines，consensus and evidence-based evidence，this paper integrates the core strategies of brain protection nursing after CPR from the dimensions of multimodal assessment of neurological function，targeted temperature management（TTM），hemodynamic optimization，hyperbaric oxygen awakening and digital intelligence rehabilitation technology. Studies have proposed that the hierarchical intervention model based on dynamic monitoring and multidisciplinary collaboration mechanism can significantly improve clinical nursing efficacy. In the future，it is necessary to further construct standardized nursing pathways and explore the application of artificial intelligence in neurological prognosis prediction，so as to promote the precise development of brain protection nursing after CPR.

Key words: Cardiopulmonary Resuscitation, Brain Protection, Current Status of Nursing, Development and Reflection

LIU Fang, LI Mengnan, GUO Yuyan, CAO Xiaobai, WANG Yujiao, YANG Qianqian. Core strategies of nursing and reflection on brain protection after cardiopulmonary resuscitation[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(7): 792-797.

References 40

[1]	李震中, 冯立群, 马青变, 等. 《2020中国心脏骤停后脑保护专家共识》解读三:药物治疗[J/OL]. 中华脑血管病杂志(电子版)2021, 15(6):356-360
	Li ZZ, Feng LQ, Ma QB, et al. Interpretation of 2020 expert consensus statement on neuroprotection after cardiac arrest in China(Ⅲ):drug therapy[J/OL]. Chin J Cerebrovasc Dis Electron Ed, 2021, 15(6):356-360.
[2]	Laver S, Farrow C, Turner D, et al. Mode of death after admission to an intensive care unit following cardiac arrest[J]. In-tensive Care Med, 2004, 30(11):2126-2128.
[3]	Aneman A, Frost S, Parr M, et al. Target temperature management following cardiac arrest:a systematic review and Bayesian meta-analysis[J]. Crit Care, 2022, 26(1):58.
[4]	徐松, 陆礼萍, 廉应涛, 等. 心搏骤停后脑复苏药物研究进展[J]. 中华危重病急救医学, 2019(3):371-374.
	Xu S, Lu LP, Lian YT, et al. Progress in pharmaceutical research for cerebral resuscitation after cardiac arrest[J]. Chin Crit Care Med, 2019(3):371-374.
[5]	Hays LMC, Udy A, Adamides AA, et al. Effects of brain tissue oxygen(PbtO₂) guided management on patient outcomes following severe traumatic brain injury:a systematic review and meta-analysis[J]. J Clin Neurosci, 2022,99:349-358.
[6]	中华医学会神经病学分会神经重症协作组. 心肺复苏后昏迷评估中国专家共识[J]. 中华神经科杂志, 2015, 48(11):965-968.
	Neurocritical Care Collaboration Group of Neurology Branch of Chinese Medical Association. China expert consensus on coma assessment after cardiopulmonary resuscitation[J]. Chin J Neurol, 2015, 48(11):965-968.
[7]	刘芳, 王晓英, 陈卫碧, 等. 成人癫痫持续状态护理专家共识[J]. 中华现代护理杂志, 2023(6):701-709.
	Liu F, Wang XY, Chen WB, et al. Expert consensus on nursing care of adults with status epilepticus[J]. Chin J Mod Nurs, 2023(6):701-709.
[8]	杜兰芳, 马青变. 《2020年中国心脏骤停后脑保护专家共识》解读一:神经功能评估[J/OL]. 中华脑血管病杂志(电子版) 2021, 15(4):228-231.
	Du LF, Ma QB. Interpretation of 2020 expert consensus statement on neuroprotection after cardiac arrest in China(Ⅰ):neurological assessment[J/OL]. Chin J Cerebrovasc Dis(Electron Ed), 2021, 15(4):228-231.
[9]	Rittenberger JC, Tisherman SA, Holm MB, et al. An early,novel illness severity score to predict outcome after cardiac arrest[J]. Resuscitation, 2011, 82(11):1399-1404. doi: 10.1016/j.resuscitation.2011.06.024 pmid: 21756969
[10]	Sandroni C, Cariou A, Cavallaro F, et al. Prognostication in comatose survivors of cardiac arrest:an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine[J]. Resuscitation, 2014, 85(12):1779-1789. pmid: 25438253
[11]	Madden LK, Hill M, May TL, et al. The implementation of targeted temperature management:an evidence-based guideline from the neurocritical care society[J]. Neurocrit Care, 2017, 27(3):468-487.
[12]	中华医学会急诊医学分会复苏学组, 中国医药教育协会急诊专业委员会, 成人心搏骤停后综合征诊断和治疗中国急诊专家共识组, 等. 成人心脏骤停后综合征诊断和治疗中国急诊专家共识[J]. 中华急诊医学杂志, 2021, 30(7):799-808.
	Resuscitation Group of Emergency Medicine Branch of the Chi-nese Medical Association, Emergency Professional Committee of the China Medical Education Association, Chinese Emergency Expert Consensus Group on Diagnosis and Treatment of Post-Cardiac Arrest Syndrome in Adults, et al. Consensus of emergency experts in China on diagnosis and treatment of adult post-cardiac arrest syndrome[J]. Chin J Emerg Med, 2021, 30(7):799-808.
[13]	Nolan JP, Sandroni C, Böttiger BW, et al. European resuscitation council and European society of intensive care medicine guidelines 2021:post-resuscitation care[J]. Resuscitation, 2021, 161:220-269.
[14]	杜兰芳, 马青变. 《2020年中国心脏骤停后脑保护专家共识》解读二:目标温度管理[J/OL]. 中华脑血管病杂志(电子版) 2021, 15(5):293-296.
	Du LF, Ma QB. Interpretation of 2020 expert consensus statement on neuroprotection after cardiac arrest in China(Ⅱ):target temperature management[J/OL]. Chin J Cerebrovasc Dis (Electron Ed), 2021, 15(5):293-296.
[15]	Mooney MR, Unger BT, Boland LL, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest:evaluation of a regional system to increase access to cooling[J]. Circulation, 2011, 124(2):206-214.
[16]	Newell C, Grier S, Soar J. Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation[J]. Crit Care, 2018, 22(1):190.
[17]	Miraglia D, Miguel LA, Alonso W. Long-term neurologically intact survival after extracorporeal cardiopulmonary resuscitation for in-hospital or out-of-hospital cardiac arrest:a systematic review and meta-analysis[J]. Resusc Plus, 2020, 4:100045.
[18]	Hirsch KG, Abella BS, Amorim E, et al. Critical care management of patients after cardiac arrest:a scientific statement from the American heart association and neurocritical care society[J]. Circulation, 2024, 149(2):e168-e200.
[19]	程一恒, 凌冬兰, 许川徽, 等. 成年人重症脑损伤患者颅内高压护理的最佳证据总结[J]. 中国实用护理杂志, 2023, 39(26):2051-2059.
	Cheng YH, Ling DL, Xu CH, et al. Summary of the best evidence for intracranial hypertension care in adults with severe brain injury[J]. Chin J Pract Nurs, 2023, 39(26):2051-2059.
[20]	Bhate TD, McDonald B, Sekhon MS, et al. Association between blood pressure and outcomes in patients after cardiac arrest:a systematic review[J]. Resuscitation, 2015,97:1-6.
[21]	Ameloot K, Genbrugge C, Meex I, et al. Low hemoglobin levels are associated with lower cerebral saturations and poor outcome after cardiac arrest[J]. Resuscitation, 2015,96:280-286.
[22]	Schneider AG, Eastwood GM, Bellomo R, et al. Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest[J]. Resuscitation, 2013, 84(7):927-934. doi: 10.1016/j.resuscitation.2013.02.014 pmid: 23454258
[23]	Elmer J, Rittenberger JC, Faro J, et al. Clinically distinct electroencephalographic phenotypes of early myoclonus after cardiac arrest[J]. Ann Neurol, 2016, 80(2):175-184. doi: 10.1002/ana.24697 pmid: 27351833
[24]	Seder DB, Sunde K, Rubertsson S, et al. Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest[J]. Crit Care Med, 2015, 43(5):965-972. doi: 10.1097/CCM.0000000000000880 pmid: 25654176
[25]	Dhakar MB, Sivaraju A, Maciel CB, et al. Electro-clinical characteristics and prognostic significance of post anoxic myoclonus[J]. Resuscitation, 2018,131:114-120.
[26]	Beuchat I, Sivaraju A, Amorim E, et al. MRI-EEG correlation for outcome prediction in postanoxic myoclonus:a multicenter study[J]. Neurology, 2020, 95(4):e335-e341.
[27]	Kongpolprom N, Cholkraisuwat J. Neurological prognostications for the therapeutic hypothermia among comatose survivors of cardiac arrest[J]. Indian J Crit Care Med, 2018, 22(7):509-518.
[28]	刘芳, 王宇娇, 曹笑柏, 等. 成人重症患者颅内压增高防控护理专家共识[J]. 中华护理杂志, 2024, 59(21):2606-2610. doi: 10.3761/j.issn.0254-1769.2024.21.007
	Liu F, Wang YJ, Cao XB, et al. Expert consensus on the prevention and control of intracranial hypertension in adult critical illness[J]. Chin J Nurs, 2024, 59(21):2606-2610. doi: 10.3761/j.issn.0254-1769.2024.21.007
[29]	Weijs PJM, Looijaard WGPM, Dekker IM, et al. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients[J]. Crit Care, 2014, 18(2):R12.
[30]	Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline:Clinical nutrition in the intensive care unit[J]. Clin Nutr, 2023, 42(9):1671-1689.
[31]	国家急诊医学专业医疗质量控制中心, 北京市急诊质量控制和改进中心, 中华护理学会急诊护理专业委员会. 急危重症患者鼻空肠营养管管理专家共识[J]. 中华急诊医学杂志, 2024, 33(6):761-766.
	National Center for Quality Control in Emergency Medicine, Beijing Emergency Quality Control and Improvement Center, Emergency Nursing Professional Committee of Chinese Nursing Association. Expert consensus on the management of nasojejunal nutrition tubes in critically ill patients[J]. Chin J Emerg Med, 2024, 33(6):761-766.
[32]	刘芳, 高岚, 王晓英, 等. 神经重症患者肠内喂养护理专家共识[J]. 中华护理杂志, 2022, 57(3):261-264. doi: 10.3761/j.issn.0254-1769.2022.03.001
	Liu F, Gao L, Wang XY, et al. Expert consensus on enteral feeding nursing for patients with severe neurological diseases[J]. Chin J Nurs, 2022, 57(3):261-264. doi: 10.3761/j.issn.0254-1769.2022.03.001
[33]	牛锋, 何岱昆, 李玉芳, 等. 高压氧在心肺复苏后脑损伤治疗中的临床价值[J]. 中国初级卫生保健, 2016, 30(11):87-88,64.
	Niu F, He DK, Li YF, et al. The clinical value of hyperbaric oxygen in the treatment of brain damage afer cardiopulmonary resuscitation[J]. Chin Prim Health Care, 2016, 30(11):87-88,64.
[34]	Gottfried I, Schottlender N, Ashery U. Hyperbaric oxygen treatment-from mechanisms to cognitive improvement[J]. Biomole-cules, 2021, 11(10):1520.
[35]	Kohshi K, Yokota A, Konda N, et al. Intracranial pressure responses during hyperbaric oxygen therapy[J]. Neurol Med Chir, 1991, 31(9):575-581.
[36]	高压氧在脑复苏中的应用专家共识组. 高压氧在脑复苏中的应用专家共识[J]. 中华急诊医学杂志, 2019, 28(6):682-690.
	Expert Consensus Group on the Application of Hyperbaric Oxygen in Brain Resuscitation. Expert consensus on the application of hyperbaric oxygen in brain resuscitation[J]. Chin J Emerg Med, 2019, 28(6):682-690.
[37]	刘金强, 高建凯, 刘亚杰, 等. 高压氧治疗心肺复苏后阵发性交感神经过度兴奋综合征[J]. 中华实用诊断与治疗杂志, 2023, 37(12):1255-1259.
	Liu JQ, Gao JK, Liu YJ, et al. Hyperbaric oxygen therapy for paroxysmal sympathetic hyperactivity syndrome after cardiopulmonary resuscitation[J]. J Chin Pract Diagn Ther, 2023, 37(12):1255-1259.
[38]	Chen XL, Li DZ, He L, et al. The prevalence of anxiety and depression in cardiac arrest survivors:a systematic review and meta-analysis[J]. Gen Hosp Psychiatry, 2023,83:8-19.
[39]	刘马超, 杭莺, 费甄甄. 体外心肺复苏患者神经系统并发症的护理进展[J]. 中华护理杂志, 2023, 58(20):2552-2557. doi: 10.3761/j.issn.0254-1769.2023.20.017
	Liu MC, Hang Y, Fei ZZ. Research progress on nursing measures of neurological complications in patients undergoing extracorporeal cardiopulmonary resuscitation[J]. Chin J Nurs, 2023, 58(20):2552-2557. doi: 10.3761/j.issn.0254-1769.2023.20.017
[40]	Yan SJ, Gan Y, Jiang N, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis[J]. Crit Care, 2020, 24(1):61.

Core strategies of nursing and reflection on brain protection after cardiopulmonary resuscitation

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