JAMA:心脏停搏昏迷患者体温控制时间对患者神经恢复的影响

2017-07-27 zhangfan MedSci原创

研究认为,延长心脏停搏昏迷患者的体温控制时间至48小时,可改善患者神经系统恢复并降低死亡率,但收益并不显著

目前国际复苏指南推荐心脏停搏昏迷患者的ICU体温控制(TTM)温度为33-36 C°,至少24小时。但延长TTM的持续时间对患者恢复的影响尚不确定。近日研究人员考察了TTM 33°C,48小时与标准的24小时TTM对于患者神经系统预后的影响。

研究在欧洲的6个国家的10个医疗中心的ICU病房进行,共收录了355例心脏停搏昏迷成年患者。参与者随机进行TTM (33±1°C) 48小时护理(n=176) 或者24小时护理(n=179)。随后以每小时0.5°C的速度逐渐恢复至37°C。主要终点为6个月的脑功能分类(CPC)评分以评估神经系统恢复,次要终点包括6个月死亡率,死亡时间,不良事件发生率和ICU资源消耗。

参与研究的355名患者,平均年龄60岁,83%为男性,其中99%的患者完成了临床研究。研究发现,6个月的神经系统评估中,69%的48小时组患者以及64%的24小时组患者,其恢复较好(差异性,4.9%;95% CI,-5%-14.8%; 相对风险 1.08; 95% CI, 0.93-1.25; P=0.33)。6个月的死亡风险,48小时组为27%,24小时组为34%(差异, -6.5%;95% CI,-16.1%-3.1%;RR,0.81;95% CI,0.59-1.11;P=0.19)。但组间患者死亡之间无显著差异(风险比, 0.79; 95% CI, 0.54-1.15; P=0.22)。48小时组患者不良事件率更高,97%vs91%。48小时组患者ICU护理时间延长(151 vs 117小时; P<0.001),但总住院时间无显著差异(11 vs 12 天; P=0.50)。

研究认为,延长心脏停搏昏迷患者的体温控制时间至48小时,可改善患者神经系统恢复并降低死亡率,但收益并不显著。

原始出处:


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    2017-08-01 虈亣靌

    很不错学习了多谢分享

    0

  3. 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    2017-08-01 lou.minghong

    学习了谢谢分享!

    0

  4. 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    2017-07-31 QQ25ed180f

    冰帽用于临床抢救中。

    0

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    2017-07-29 往日如昨

    学习了谢谢分享

    0

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    2017-07-29 往日如昨

    学习了谢谢分享

    0

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likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Jul 27 13:12:31 CST 2017, time=2017-07-27, status=1, ipAttribution=)]
    2017-07-29 wgx307
  8. 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Fri Jul 28 09:49:14 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227120, encodeId=28b622e12029, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Jul 28 07:29:44 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226914, encodeId=cd612269142f, content=讲解的非常好,值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Jul 27 13:12:31 CST 2017, time=2017-07-27, status=1, ipAttribution=)]
    2017-07-28 妇产软妹子

    有用

    0

  9. 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Fri Jul 28 09:49:14 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227120, encodeId=28b622e12029, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Jul 28 07:29:44 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226914, encodeId=cd612269142f, content=讲解的非常好,值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Jul 27 13:12:31 CST 2017, time=2017-07-27, status=1, ipAttribution=)]
    2017-07-28 ylzr123

    认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦

    0

  10. 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Fri Jul 28 09:49:14 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227120, encodeId=28b622e12029, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Jul 28 07:29:44 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226914, encodeId=cd612269142f, content=讲解的非常好,值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Jul 27 13:12:31 CST 2017, time=2017-07-27, status=1, ipAttribution=)]
    2017-07-27 虈亣靌

    讲解的非常好,值得学习

    0

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新英格兰:心脏停搏昏迷生存者的目标体温管理

  1名62岁的男性倒在街上,被叫到现场的急救医疗人员发现,这名男子没有呼吸,也没有脉搏。最早记录到的心律是室颤。加强心脏生命支持措施,包括插管,总剂量为2 mg的肾上腺素,以及6次心脏除颤尝试,使病人在事发后22分钟恢复了自主循环。当病人入住急诊部时,他的病情为血流动力学稳定,并且氧合充分,通气充足,但他仍然昏迷。神经病学检查显示,瞳孔对光反射存在以及咳嗽反射阳性。核心体温为35.5°C。病人被

CCQO:院外心脏停搏患者生存结局得到显著改善,但仍存在区域差异

莫纳什大学Nehme Z等人通过对维多利亚急救心脏停搏注册表的数据研究,地域和时间跨度上分析了心肺复苏的趋势,事件生存率,出院生存率,研究成果发表在1月份Circulation Cardiovascular quality and outcomes期刊上。 背景:虽然临床登记的价值已经在发达国家得到了很好的认可,但是其用于衡量急诊医疗质量仍然比较陌生。研究提出了一个全州急诊医疗监督举

NEJM:院内心脏停搏或不影响老年生存者的远期转归

对于院内心脏停搏的老年生存者的远期转归我们所知甚少。日前,美国心脏学会遵循心肺复苏指南研究者,以及来自美国密苏里州堪萨斯城圣路加中美心脏研究所的研究人员明确了院内心脏停搏生存者的长期生存率和再入院率,并且对这些转归是否根据人口学统计学特征和出院时的神经功能状态而产生变化进行了研究。 临床医生通常认为院内心脏猝死幸存者,尤其是其中的老年人远期预后不良。该项新研究对这种看法提出了质疑,显示65岁以上

仅按压胸部心肺复苏术效果更好

2010年10月06日 来源:美国科学促进会 据10月6日刊《美国医学会杂志》(JAMA)上的一项研究显示, 对亚利桑那州的医院外心肺复苏术(CPR)的后果进行比较后发现,接受由旁观者所做的仅按压胸部的心肺复苏术的心脏停搏病人要比那些接受常规心肺复苏术或没有接受心肺复苏术的患者更有可能活着出院。   医院外心脏停搏是一个严重的公共卫生问题,美国每年大约有30万人会发生这种情况。 尽管这些患者