Wigginton Jane G, Pepe Paul E, Bedolla John P, DeTamble Lucy A, Atkins James M
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-8579, USA.
Crit Care Med. 2002 Apr;30(4 Suppl):S131-6. doi: 10.1097/00003246-200204001-00002.
To examine whether previously observed sex-related differences in coronary artery disease syndromes also apply to patients with out-of-hospital sudden cardiac arrest, a probable subset of patients with coronary artery disease who are easy to recognize and are treated in a standardized fashion.
Prospective, population-based study conducted over a 6-yr period.
A large urban municipality (population, 1.1 million) served by a single emergency medical services system with centralized medical direction and standardized protocols.
All patients with out-of-hospital, nontraumatic, primary cardiac arrest.
Standardized advanced cardiac life support protocols.
During the 6 yrs of the study, 4147 consecutive patients were studied, 42% of whom were women (p <.001). Although women were significantly older than men (mean age, 68.7 +/- 18 vs. 61.7 +/- 17 yrs; p =.001), there were no significant differences for the percentages of witnessed and unwitnessed arrests, response intervals, and the length and type of treatment provided. Although men were more likely to have ventricular fibrillation/ventricular tachycardia on presentation (41% vs. 30%), women had more asystole (8.8% vs. 7%) and (organized) pulseless electrical activity than men (24% vs. 18%; p <.001). Nevertheless, more women were resuscitated (13.5% vs. 10.7%; p =.005), particularly women with non-ventricular fibrillation/ventricular tachycardia presentation (12.6% vs. 9.6%; p <.02). These differences were more pronounced when controlling for age (95% confidence interval, 1.44 [1.25-1.74]).
In cases of out-of-hospital sudden cardiac arrest, women have significantly better resuscitation rates than men, especially when controlling for age, particularly among women with non-ventricular fibrillation/ventricular tachycardia presentations. Additional studies are required to validate these observations, not only for long-term survival and external validity, but also for other potential genetic factors and potential discrepancies with other studies.
研究先前观察到的冠状动脉疾病综合征中与性别相关的差异是否也适用于院外心脏骤停患者，院外心脏骤停患者可能是冠状动脉疾病患者中的一个易于识别且接受标准化治疗的亚组。
为期6年的基于人群的前瞻性研究。
由单一紧急医疗服务系统服务的一个大城市（人口110万），该系统具有集中医疗指导和标准化方案。
所有院外非创伤性原发性心脏骤停患者。
标准化的高级心脏生命支持方案。
在研究的6年期间，连续研究了4147例患者，其中42%为女性（p<0.001）。尽管女性比男性年龄显著更大（平均年龄68.7±18岁对61.7±17岁；p = 0.001），但目击和非目击心脏骤停的百分比、反应间隔以及所提供治疗的时长和类型并无显著差异。尽管男性就诊时更易出现心室颤动/室性心动过速（41%对30%），但女性出现心搏停止（8.8%对7%）和（有组织的）无脉电活动的比例高于男性（24%对18%；p<0.001）。然而，更多女性被复苏成功（13.5%对10.7%；p = 0.005），尤其是非心室颤动/室性心动过速表现的女性（12.6%对9.6%；p<0.02）。在控制年龄后这些差异更为明显（95%置信区间，1.44 [1.25 - 1.74]）。
在院外心脏骤停病例中，女性的复苏成功率显著高于男性，尤其是在控制年龄后，特别是在非心室颤动/室性心动过速表现的女性中。需要进一步研究来验证这些观察结果，不仅针对长期生存率和外部有效性，还针对其他潜在遗传因素以及与其他研究的潜在差异。
