心肺复苏后的严重出血并发症：溶栓治疗的影响

Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment.

作者信息

Kurkciyan I, Meron G, Sterz F, Müllner M, Tobler K, Domanovits H, Schreiber W, Bankl H C, Laggner A N

机构信息

Department of Emergency Medicine, Institute of Clinical Pathology, General Hospital of Vienna, University of Vienna, Währinger Gürtel 18-20/6D, 1090 Vienna, Austria.

出版信息

J Intern Med. 2003 Feb;253(2):128-35. doi: 10.1046/j.1365-2796.2003.01079.x.

DOI:10.1046/j.1365-2796.2003.01079.x

PMID:12542552

Abstract

OBJECTIVE

The risk of bleeding complications caused by thrombolysis in patients with cardiac arrest and prolonged cardiopulmonary resuscitation is unclear. We evaluate the complication rate of systemic thrombolysis in patients with out-of-hospital cardiac arrest caused by acute myocardial infarction, especially in relation to duration of cardiopulmonary resuscitation.

DESIGN

The study was designed as retrospective cohort study, the risk factor being systemic thrombolysis and the end-point major haemorrhage, defined as life-threatening and/or need for transfusion. Over 10.5 years, emergency cardiac care data, therapy, major haemorrhage and outcome of 265 patients with acute myocardial infarction admitted to an emergency department after successful cardiopulmonary resuscitation were registered.

RESULTS

We observed major haemorrhage in 13 of 132 patients who received thrombolysis (10%, 95% confidence interval 5-15%), five of these survived to discharge, none died because of this complication. Major haemorrhage occurred in seven of 133 patients in whom no thrombolytic treatment had been given (5%, 95% confidence interval 1-9%), two of these survived to discharge. Taking into account baseline imbalances between the groups, the risk of bleeding was slightly increased if thrombolytics were used (odds ratio 2.5, 95% confidence interval 0.9-7.4) but this was not significant (P = 0.09). There was no clear association between duration of resuscitation and bleeding complications (z for trend = 1.52, P = 0.12). Survival was not significantly better in patients receiving thrombolysis (odds ratio 1.6, 0.9-3.0, P = 0.12).

CONCLUSIONS

Bleeding complications after cardiopulmonary resuscitation are frequent, particularly in patients with thrombolytic treatment, but do not appear to be related to the duration of resuscitation. In the light of possible benefits on outcome, thrombolytic treatment should not be withheld in carefully selected patients.

摘要

目的

心脏骤停且长时间心肺复苏患者接受溶栓治疗后发生出血并发症的风险尚不清楚。我们评估急性心肌梗死导致院外心脏骤停患者全身溶栓的并发症发生率，尤其是与心肺复苏持续时间的关系。

设计

本研究设计为回顾性队列研究，危险因素为全身溶栓，终点为严重出血，定义为危及生命和/或需要输血。在10.5年期间，记录了265例心肺复苏成功后入住急诊科的急性心肌梗死患者的急诊心脏护理数据、治疗情况、严重出血情况及转归。

结果

我们观察到，132例接受溶栓治疗的患者中有13例发生严重出血（10%，95%置信区间5 - 15%），其中5例存活出院，无一例因该并发症死亡。133例未接受溶栓治疗的患者中有7例发生严重出血（5%，95%置信区间1 - 9%），其中2例存活出院。考虑到组间基线不平衡，使用溶栓药物时出血风险略有增加（比值比2.5，95%置信区间0.9 - 7.4），但差异无统计学意义（P = 0.09）。复苏持续时间与出血并发症之间无明显关联（趋势z值 = 1.52，P = 0.12）。接受溶栓治疗的患者生存率改善不显著（比值比1.6，0.9 - 3.0，P = 0.12）。