急诊

心脏骤停后复苏应用体内和体外目标体温管理方法的随机对照试验

作者:姜辉 来源:急诊界 日期:2017-08-10
导读

         心脏骤停后复苏应用目标体温管理可采用不同的方法,大致分为体内降温与外部降温2种方法。本研究旨在针对采用体内和外部降温的心脏骤停后复苏的患者,评价其存活出院存活率和神经功能预后(格拉斯哥评分)。

        Randomized controlled trial of internal and external targeted temperature management methods inpost- cardiac arrest patients.

        心脏骤停后复苏应用体内和体外目标体温管理方法的随机对照试验

        BACKGROUND

        Targeted temperature managementpost-cardiac arrest is currently implemented using various methods, broadly categorized as internal and external. This study aimed to evaluate survival-to-hospital discharge and neurological outcomes (Glasgow-Pittsburgh Score) ofpost-cardiac arrest patients undergoing internal cooling verses external cooling.

        背景:心脏骤停后复苏应用目标体温管理可采用不同的方法,大致分为体内降温外部降温2种方法。本研究旨在针对采用体内和外部降温的心脏骤停后复苏的患者,评价其存活出院存活率和神经功能预后(格拉斯哥评分)。

        METHODOLOGY

        A randomized controlled trial ofpost-resuscitationcardiac arrest patients was conducted from October 2008-September 2014. Patients were randomized to either internal or external cooling methods. Historical controlswere selected matched by age and gender. Analysis using SPSS version 21.0 presented descriptive statistics and frequencies while univariate logistic regression was done using R 3.1.3.

        方法:从2008年10月至2014年9月进行了一项针对心脏骤停后复苏患者的随机对照试验。患者被随机分配为进行体内或外部降温方法。按年龄和性别进行匹配。采用spss 软件21.0进行描述数据和频率,同时应用R 3.1.3进行单变量logistic回归分析。

        RESULTS

        23 patients were randomized to internal cooling and 22 patients to external cooling and 42 matched controls were selected. No significant difference was seen between internal and external cooling in terms of survival, neurological outcomes and complications. However in the internal cooling arm, there was lower risk of developing overcooling (p=0.01) and rebound hyperthermia (p=0.02). Compared to normothermia, internal cooling had higher survival (OR=3.36, 95% CI=(1.130, 10.412), and lower risk of developing cardiac arrhythmias (OR=0.18, 95% CI=(0.04, 0.63)). Subgroup analysis showed those with cardiac cause of arrest (OR=4.29, 95% CI=(1.26, 15.80)) and sustained ROSC (OR=5.50, 95% CI=(1.64, 20.39)) had better survival with internal cooling compared to normothermia. Cooling curves showed tighter temperature control for internal compared to external cooling.

        结果:23例患者被随机分配到体内降温组,22例分配到外部降温组,42例相匹配的患者为对照组。在体内降温组和外部降温组患者的存活率、神经功能预后及并发症均无显著性差异。然而,体内降温组有更低的体温过低和高温反弹的风险。

        与常温相比,体内降温组有更高的生存率(OR = 3.36,95 %ci = 1.130 (10.412),更低的心律失常的风险(OR = 0.18,95 %ci =(0.04, 0.63))。亚组分析显示,与常温组比较,那些心源性心脏骤停的患者(OR = 4.29,95 %ci =(1.26, 15.80)) 和持续性ROSC的患者(OR = 5.50,95 %ci =(1.64, 20.39)) 有更好的存活率。降温曲线表明与外部降温组相比,体内降温组有更严格的温度控制。

        CONCLUSION

        Internal cooling showed tighter temperature control compared to external cooling. Internal cooling can potentially provide better survival-to-hospital discharge outcomes and reduce cardiac arrhythmia complications in carefully selected patients as compared to normothermia.

        结论:与外部降温组相比,体内降温组有更严格的温度控制。与正常体温组比较,某些选定的患者中体内降温可能有更好的出院存活率,并且有更低的心律失常并发症的发生。

        翻译:北京协和医院研究生 姜辉

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