BMJ:休克性院内心脏骤停患者除颤前慎用肾上腺素

2021-11-16 MedSci原创 MedSci原创

在室性心律失常引起的院内心脏骤停患者救治过程中,近三成的患者违背现行指南,在除颤前进行了肾上腺素治疗,这与患者不良预后相关

在美国,每年有近30万患者发生住院期间心脏骤停,出院存活率仅为25%。心脏骤停患者的救护方式与心脏节率相关:对于心脏停搏或无脉搏电活动患者,指南建议每三到五分钟进行一次肾上腺素注射;而对于休克性心律或无脉搏性室性心动过速的患者则建议在2分钟内立即除颤后,再注射肾上腺素。近日研究人员考察了在除颤前使用肾上腺素对因室性心律失常引起的院内心脏骤停患者生存的影响。

本次研究为倾向匹配分析,收集了2000-2018年间497家美国心脏协会认证医院数据,参与者为成年的室性心律失常院内心脏骤停患者,患者最初因接受除颤治疗住院,考察是否在首次除颤前接受肾上腺素,研究的主要终点为出院生存、神经系统功能良好存活(无、轻度或中度神经功能障碍)以及复苏后生存(即自发循环恢复>20分钟)。

34820名患者参与研究,其中9630人(27.6%)在除颤前接受了肾上腺素,违背了指南意见。相比于先行除颤患者,先接受肾上腺素治疗的参与者无心肌梗死或心力衰竭病史,但存在肾功能衰竭、脓毒症、肺炎及机械通气史。除颤前使用肾上腺素与延迟除颤密切相关(平均时间:3分钟 vs 0分钟)。在包含9011对匹配患者的倾向匹配分析中,除颤前肾上腺素与出院生存率(25.2% vs 29.9%;校正优势比0.81)、神经系统功能良好存活(18.6% vs 21.4%;0.85)以及复苏后生存率(64.4% vs 69.4%;0.76)降低相关。

除颤、肾上腺素使用与出院存活率

研究发现,在室性心律失常引起的院内心脏骤停患者救治过程中,近三成的患者违背现行指南,在除颤前进行了肾上腺素治疗,这与患者不良预后相关。

原始出处:

Erin Evans et al. Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis.BMJ. 10 November,2021.

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    2022-03-22 25887131

    学习了

    0

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    2021-11-26 gaoxiaoe
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    2021-11-18 zhouqu_8
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    2021-11-17 junebenf

    学习了

    0

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    2021-11-17 moyanju2796

    学习了。

    0

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    2021-11-17 ms6000000800992147

    学习了

    0

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