Tsai Min-Shan, Huang Chien-Hua, Chang Wei-Tien, Chen Wen-Jone, Hsu Chiung-Yuan, Hsieh Cheng-Chun, Yang Chih-Wei, Chiang Wen-Chu, Ma Matthew Huei-Ming, Chen Shyr-Chyr
Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, Taipei 100, Taiwan.
Am J Emerg Med. 2007 Mar;25(3):318-25. doi: 10.1016/j.ajem.2006.12.007.
Several studies have disclosed the importance of serum adrenocorticotropic hormone and cortisol levels in resuscitation. The objective of this study was to observe the effect of hydrocortisone on the outcome of out-of-hospital cardiac arrest (OHCA) patients.
Prospective, nonrandomized, open-labeled clinical trial.
Emergency department (ED) of National Taiwan University Hospital.
Ninety-seven nontraumatic adult OHCA victims.
Serum adrenocorticotropic hormone and total cortisol levels were examined in all patients. The hydrocortisone group (n = 36) received 100 mg intravenous hydrocortisone during resuscitation, and the nonhydrocortisone group (n = 61) received 0.9% saline as placebo.
Comparison of return of the spontaneous circulation (ROSC) rates between the 2 groups was analyzed. The hydrocortisone group had a significantly higher ROSC rate than the nonhydrocortisone group (61% vs 39%, P = .038). Hydrocortisone administration within 6 minutes after ED arrival led to an increased ROSC rate (90% vs 50%, P = .045). The hydrocortisone and nonhydrocortisone groups did not differ in the development of electrolyte disturbances, gastrointestinal tract bleeding, or infection during early postresuscitation period (gastrointestinal bleeding: 41% vs 46%, P = .89; infection: 50% vs 75%, P = .335). There was no significant difference between the hydrocortisone and nonhydrocortisone groups in terms of 1- and 7-day survival and hospital discharge rates.
Hydrocortisone treatment during resuscitation, particularly when administrated within 6 minutes of ED arrival, may be associated with an improved ROSC rate in OHCA patients.
多项研究揭示了血清促肾上腺皮质激素和皮质醇水平在复苏中的重要性。本研究的目的是观察氢化可的松对院外心脏骤停（OHCA）患者预后的影响。
前瞻性、非随机、开放标签的临床试验。
台湾大学附属医院急诊科。
97名非创伤性成年OHCA受害者。
检测所有患者的血清促肾上腺皮质激素和总皮质醇水平。氢化可的松组（n = 36）在复苏期间静脉注射100 mg氢化可的松，非氢化可的松组（n = 61）接受0.9%生理盐水作为安慰剂。
分析两组自主循环恢复（ROSC）率的比较。氢化可的松组的ROSC率显著高于非氢化可的松组（61%对39%，P = 0.038）。在急诊科到达后6分钟内给予氢化可的松可提高ROSC率（90%对50%，P = 0.045）。氢化可的松组和非氢化可的松组在复苏后早期电解质紊乱、胃肠道出血或感染的发生情况方面无差异（胃肠道出血：41%对46%，P = 0.89；感染：50%对75%，P = 0.335）。氢化可的松组和非氢化可的松组在1天和7天生存率及出院率方面无显著差异。
复苏期间使用氢化可的松治疗，尤其是在急诊科到达后6分钟内给药，可能与OHCA患者ROSC率的提高有关。
