Circulation:静脉或骨内给药对院外心脏骤停患者预后的影响

2020-02-01 QQY MedSci原创

抗心律失常药物还没有被证明能显著提高由休克难治性心室颤动/无脉性室性心动过速引起的院外心脏骤停的总生存率。而且给药途径如何影响这一点也尚不清楚。在一项随机化、安慰剂为对照的临床试验的判断分析中,研究人员对比了在ALPS试验中由急救医疗人员随机分配抗心律失常药物vs安慰剂的休克难治性室颤/无脉性室速患者的生存期和出院期的差异,并根据静脉和骨内给药分层。共3019位被随机分配的患者,2358例经静脉通

抗心律失常药物还没有被证明能显著提高由休克难治性心室颤动/无脉性室性心动过速引起的院外心脏骤停的总生存率。而且给药途径如何影响这一点也尚不清楚。

在一项随机化、安慰剂为对照的临床试验的判断分析中,研究人员对比了在ALPS试验中由急救医疗人员随机分配抗心律失常药物vs安慰剂的休克难治性室颤/无脉性室速患者的生存期和出院期的差异,并根据静脉和骨内给药分层。

共3019位被随机分配的患者,2358例经静脉通路予以ALPS,661例经骨内途径给药。骨内和静脉给药组在性别、紧急医疗服务到达时间和一些心肺复苏特征上有所不同,但在其他方面相似,包括给药时间。总出院存活率为23%。与安慰剂相比,接受静脉予以胺碘酮或利多卡因的患者的出院存活率明显更高(校正风险比分别是1.26[95% CI, 1.5–9.5]和1.21 [95% CI, 1.02–1.45]),但接受骨内予以胺碘酮或利多卡因的患者的出院存活率无明显差异。静脉给药而非骨内给药还可显著提高住院存活率,有利于改善出院时的神经功能。静脉和骨内安慰剂组之间没有明显差异,提示通路本身并不能区分预后不良的患者。

研究人员发现院外心脏骤停时,与安慰剂相比,胺碘酮或利多卡因的给药途径对疗效无明显影响。但与安慰剂相比,静脉注射两种药物的作用均明显大于骨内途径,且仅静脉注射途径有效。本研究发现提示了复苏过程中给药途径的潜在重要性,但该研究在统计评估相互作用方面稍有欠缺,需进一步进行研究。

原始出处:

本文系梅斯医学(MedSci)原创编译,转载需授权!

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1692102, encodeId=37d31692102fd, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Wed Jun 10 08:57:00 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821276, encodeId=c43918212e6dc, content=<a href='/topic/show?id=0b1110160e4c' target=_blank style='color:#2F92EE;'>#骨内给药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101607, encryptionId=0b1110160e4c, topicName=骨内给药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Fri Dec 25 17:57:00 CST 2020, time=2020-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698029, encodeId=537e16980292b, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Nov 02 21:57:00 CST 2020, time=2020-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305673, encodeId=f11613056e36f, content=<a href='/topic/show?id=1787983537c' target=_blank style='color:#2F92EE;'>#院外心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98353, encryptionId=1787983537c, topicName=院外心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b96f328, createdName=wwzzly, createdTime=Mon Feb 03 01:57:00 CST 2020, time=2020-02-03, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1692102, encodeId=37d31692102fd, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Wed Jun 10 08:57:00 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821276, encodeId=c43918212e6dc, content=<a href='/topic/show?id=0b1110160e4c' target=_blank style='color:#2F92EE;'>#骨内给药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101607, encryptionId=0b1110160e4c, topicName=骨内给药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Fri Dec 25 17:57:00 CST 2020, time=2020-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698029, encodeId=537e16980292b, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Nov 02 21:57:00 CST 2020, time=2020-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305673, encodeId=f11613056e36f, content=<a href='/topic/show?id=1787983537c' target=_blank style='color:#2F92EE;'>#院外心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98353, encryptionId=1787983537c, topicName=院外心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b96f328, createdName=wwzzly, createdTime=Mon Feb 03 01:57:00 CST 2020, time=2020-02-03, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1692102, encodeId=37d31692102fd, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Wed Jun 10 08:57:00 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821276, encodeId=c43918212e6dc, content=<a href='/topic/show?id=0b1110160e4c' target=_blank style='color:#2F92EE;'>#骨内给药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101607, encryptionId=0b1110160e4c, topicName=骨内给药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Fri Dec 25 17:57:00 CST 2020, time=2020-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698029, encodeId=537e16980292b, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Nov 02 21:57:00 CST 2020, time=2020-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305673, encodeId=f11613056e36f, content=<a href='/topic/show?id=1787983537c' target=_blank style='color:#2F92EE;'>#院外心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98353, encryptionId=1787983537c, topicName=院外心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b96f328, createdName=wwzzly, createdTime=Mon Feb 03 01:57:00 CST 2020, time=2020-02-03, status=1, ipAttribution=)]
    2020-11-02 fusion
  4. [GetPortalCommentsPageByObjectIdResponse(id=1692102, encodeId=37d31692102fd, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Wed Jun 10 08:57:00 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821276, encodeId=c43918212e6dc, content=<a href='/topic/show?id=0b1110160e4c' target=_blank style='color:#2F92EE;'>#骨内给药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101607, encryptionId=0b1110160e4c, topicName=骨内给药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Fri Dec 25 17:57:00 CST 2020, time=2020-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698029, encodeId=537e16980292b, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Nov 02 21:57:00 CST 2020, time=2020-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305673, encodeId=f11613056e36f, content=<a href='/topic/show?id=1787983537c' target=_blank style='color:#2F92EE;'>#院外心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98353, encryptionId=1787983537c, topicName=院外心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b96f328, createdName=wwzzly, createdTime=Mon Feb 03 01:57:00 CST 2020, time=2020-02-03, status=1, ipAttribution=)]

相关资讯

万米高空航班上乘客心脏骤停,重庆女医生抢出“黄金4分钟”

“万米高空,遇到乘客头痛呕吐意识障碍,脉搏测不出,呼医者,上前协作,评估,吸氧,CPR……头等舱变成临时抢救室……病人心跳、意识恢复、好转,飞机紧急降落,病人落地救治,耳边传来掌声、称赞声……顿时觉得平凡的工作有了不平凡的意义,回到座位继续‘啃’三篇医学指南,敬佑生命,大爱无疆!”12月1日,重庆市急救医疗中心神经内科张艳医生的一条朋友圈,收获了网友的大量点赞。当天,在重庆飞往北京的万米高空之上,

心脏骤停基层诊疗指南(实践版·2019)

心脏骤停是猝死的主要原因。心脏骤停是指心脏突然停止射血,造成循环停止而产生的一系列症状、体征,包括意识丧失、晕厥和大动脉搏动消失。本文在描述死亡方式时使用“猝死”这一术语,但涉及其直接原因、临床表现和治疗抢救时,使用“心脏骤停”这一术语,二者不应混淆。

心脏骤停复苏后血流动力学管理的专家共识

影响ROSC患者预后的主要因素是CA后综合征,包括伴随循环休克的心肌功能障碍,伴随凝血系统激活的系统性炎症,不断进展的脑损伤以及持续存在的病理学变化嘲。复苏后心肌功能障碍是导致患者早期死亡的主要原因之一叫,其中机械因素包括严重的心肌收缩力损伤和心肌舒张功能不全;电生理因素包括各种心律失常,甚至交感电风暴。这些因素引起血流动力学不稳定,最终可能导致多器官功能衰竭。CA患者存在复苏后心肌功能障碍的同时

心脏骤停基层诊疗指南:心脏骤停救治的八大要点

心脏骤停具有突发性和不可预知性,心脏骤停的识别和救治技能应普及到所有基层医务人员、公共场所服务人员,甚至逐渐推广到全社会。近日,中华医学会发布了《心脏骤停基层诊疗指南(2019年)》,指南强调了心脏骤停救治八大要点。1 心肺复苏(CPR)适用于院外未被目击或院内外不能立即获得除颤器/自动体外除颤器(AED)的心脏骤停CPR的正确方法:将患者放平至较硬平面上,施救者位于患者身体右侧,可在患者两侧

NEJM:心脏骤停后早期呼吸机相关性肺炎的预防

由此可见,在院外心脏骤停后初始电击节律后接受32至34°C的目标温度管理策略的患者中,相比于安慰剂,使用2天疗程的阿莫西林-克拉维酸抗生素治疗可降低早期呼吸机相关性肺炎的发生率,其他关键临床变量(如无呼吸机天数和第28天死亡率)没有观察到显著的组间差异。

PLos One:院外心脏骤停后低温治疗可以提高选定患者的1年生存率

低温治疗患者在神经系统预后改善方面未显示出明显的获益。室颤后接受TH治疗的患者1年生存率获益最大,而心脏停搏患者仅在年龄小于65岁时才有中等获益。