心脏停搏抢救过程中维持血压对近期预后的影响

doi:10.3969/j.issn.1002-1949.2016.05.008

摘要
图/表
参考文献(17)
相关文章 (15)

全文: PDF (876 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的研究心脏停搏过程中血压的水平对近期预后的影响。方法回顾分析2011-01～2015-09 间因心脏停搏转入中国医学科学院肿瘤医院重症医学科（intensive care unit, ICU）抢救治疗的19 例患者。结果 3 例患者家属放弃抢救，最终16 例进行分析。16 例患者中男性11 例，女性5 例，年龄（57±14）岁。16 例患者中24 h 时存活8 例，死亡8 例。单因素分析发现：与存活组相比，死亡组的患者转入ICU 时的器官衰竭评分（sequential organ failure assessment，SOFA）更高（[13±2）分vs.（8±5）分，P = 0.037]、心脏停搏前更多地存在低血压（75% vs. 12.5%，P = 0.012）、肾上腺素用量更多（[5±4）mg vs.（2±2）mg，P = 0.043]、复苏时平均动脉压（mean blood pressure, MAP）更低（[57±14）mm Hg vs.（76±11）mm Hg，P = 0.008）。受试者操作曲线（receiver operating curve, ROC）分析发现，复苏时平均动脉压在62 mm Hg 时预测24 h 存活的敏感度为100%，特异度75%（曲线下面积为0.883±0.088，95%可信区间 0.711～1.055，P = 0.010）。根据复苏时MAP 是否＞62 mm Hg 分为两组，分析发现，与MAP＜62 mm Hg 的患者比较，MAP＞62 mm Hg 组的患者出院时脑功能评分无显著改善，但是病死率显著下降(50% 比100%，P = 0.037)。结论对于院内心脏停搏的患者，复苏时维持一定的平均动脉压，可以改善患者24 h存活率和30 d 病死率，但不改善脑功能评分。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	邢学忠
	王海军
	曲世宁
	张昊
	黄初林
	王浩
	杨全会
	高勇

收稿日期: 2015-11-10

通讯作者: 高勇（1964-），男，副主任医师，科主任，E-mail：2354839907@qq.com。

作者简介: 邢学忠（1972-），男，博士，副主任医师，E-mail：xingxzh2000@aliyun.com

引用本文:

邢学忠,王海军,曲世宁,张昊,黄初林,王浩,杨全会,高勇. 心脏停搏抢救过程中维持血压对近期预后的影响[J]. 中国急救医学, 2016, 36(5): 415-418.
XING Xue-zhong, WANG Hai-jun, QU Shi-ning, ZHANG Hao, HUANG Chu-lin,WANG Hao, YANG Quan-hui, GAO Yong. The effect of blood pressure during resuscitation on the short term outcome of patients suffered from cardiac arrest. Chinese Journal of Critical Care Medicine, 2016, 36(5): 415-418.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2016.05.008 或 http://www.cnemergency.org.cn/CN/Y2016/V36/I5/415

[1] Kazaure HS, Roman SA, Sosa JA. Epidemiology and outcomes of in- hospital cardiopulmonary resuscitation in the United States,2000-2009[J]. Resuscitation, 2013, 84(9): 1255-1260. [2] Yang HJ, Kim GW, Kim H, et al. Epidemiology and outcomes in out-of-hospital cardiac arrest: a report from the NEDIS-based cardiac arrest registry in Korea[J]. J Korean Med Sci, 2015, 30(1): 95-103. [3] 郑亮亮, 徐军, 于学忠. 心肺复苏过程中的质量监测[J]. 中国急救医学, 2013, 33(11): 976-980. [4] Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation,2010, 122(18 Suppl 3): S640-656. [5] Hazinski MF, Nolan JP, Aickin R,et al. Part 1: Executive Summary 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations[J]. Circulation, 2015, 132(16 Suppl 1): S2-39. [6] Kazaure HS, Roman SA, Sosa JA. Epidemiology and outcomes of in- hospital cardiopulmonary resuscitation in the United States,2000-2009[J]. Resuscitation, 2013, 84(9): 1255-1260. [7] Sutton RM, Friess SH, Naim MY, et al. Patient-centric blood pressure- targeted cardiopulmonary resuscitation improves survival from cardiac arrest[J]. Am J Respir Crit Care Med, 2014, 190(11):1255-1262. [8] Phelps R, Dumas F, Maynard C, et al. Cerebral Performance Cate⁃gory and long-term prognosis following out-of-hospital cardiac arrest[J]. Crit Care Med, 2013, 41(5): 1252-1257. [9] 李春盛, 龚平. 我国心肺复苏的近 10 年研究进展[J]. 中华急诊医学杂志, 2012, 21(1): 5-8. [10] 韩文斌, 刘巍, 宋斌, 等. 心脏骤停后心肺复苏和心肺脑复苏成功病例的对比分析[J]. 中国急救医学, 2010 ,30(4): 308-311. [11] Friess SH, Sutton RM, Bhalala U, et al. Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest[J]. Crit Care Med, 2013, 41(12):2698-2704. [12] Sutton RM, Friess SH, Bhalala U, et al. Hemodynamic directed CPR improves short- term survival from asphyxia- associated cardiac arrest[J]. Resuscitation, 2013, 84(5): 696-701. [13] Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopul⁃monary resuscitation[J]. JAMA，1990，263（8）:1106-1113. [14] Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest[J]. N Engl J Med，2002，346(8):549-556. [15] Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia[J]. N Engl J Med, 2002, 346(8): 557-563. [16] 汪润民, 高萍, 张更伟, 等. 亚低温治疗对心肺复苏患者预后的影响[J]. 中国急救复苏与灾害医学杂志, 2013,8 (9): 794-796. [17] Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest[J]. N Engl J Med, 2013, 369(23): 2197-2206.