Gueugniaud Pierre-Yves, David Jean-Stéphane, Chanzy Eric, Hubert Hervé, Dubien Pierre-Yves, Mauriaucourt Patrick, Bragança Coralie, Billères Xavier, Clotteau-Lambert Marie-Paule, Fuster Patrick, Thiercelin Didier, Debaty Guillaume, Ricard-Hibon Agnès, Roux Patrick, Espesson Catherine, Querellou Emgan, Ducros Laurent, Ecollan Patrick, Halbout Laurent, Savary Dominique, Guillaumée Frédéric, Maupoint Régine, Capelle Philippe, Bracq Cécile, Dreyfus Philippe, Nouguier Philippe, Gache Antoine, Meurisse Claude, Boulanger Bertrand, Lae Claude, Metzger Jacques, Raphael Valérie, Beruben Arielle, Wenzel Volker, Guinhouya Comlavi, Vilhelm Christian, Marret Emmanuel
Service d'Aide Médicale Urgente 69, Hospices Civils de Lyon, University of Lyon 1, Lyon, France.
N Engl J Med. 2008 Jul 3;359(1):21-30. doi: 10.1056/NEJMoa0706873.
During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective than epinephrine or vasopressin alone, but evidence is insufficient to make clinical recommendations.
In a multicenter study, we randomly assigned adults with out-of-hospital cardiac arrest to receive successive injections of either 1 mg of epinephrine and 40 IU of vasopressin or 1 mg of epinephrine and saline placebo, followed by administration of the same combination of study drugs if spontaneous circulation was not restored and subsequently by additional epinephrine if needed. The primary end point was survival to hospital admission; the secondary end points were return of spontaneous circulation, survival to hospital discharge, good neurologic recovery, and 1-year survival.
A total of 1442 patients were assigned to receive a combination of epinephrine and vasopressin, and 1452 to receive epinephrine alone. The treatment groups had similar baseline characteristics except that there were more men in the group receiving combination therapy than in the group receiving epinephrine alone (P=0.03). There were no significant differences between the combination-therapy and the epinephrine-only groups in survival to hospital admission (20.7% vs. 21.3%; relative risk of death, 1.01; 95% confidence interval [CI], 0.97 to 1.05), return of spontaneous circulation (28.6% vs. 29.5%; relative risk, 1.01; 95% CI, 0.97 to 1.06), survival to hospital discharge (1.7% vs. 2.3%; relative risk, 1.01; 95% CI, 1.00 to 1.02), 1-year survival (1.3% vs. 2.1%; relative risk, 1.01; 95% CI, 1.00 to 1.02), or good neurologic recovery at hospital discharge (37.5% vs. 51.5%; relative risk, 1.29; 95% CI, 0.81 to 2.06).
As compared with epinephrine alone, the combination of vasopressin and epinephrine during advanced cardiac life support for out-of-hospital cardiac arrest does not improve outcome. (ClinicalTrials.gov number, NCT00127907.)
在对心脏骤停进行复苏的高级心脏生命支持过程中，血管加压素和肾上腺素联合使用可能比单独使用肾上腺素或血管加压素更有效，但证据不足以做出临床推荐。
在一项多中心研究中，我们将院外心脏骤停的成年人随机分配，使其接受连续注射1mg肾上腺素和40IU血管加压素或1mg肾上腺素和生理盐水安慰剂，若未恢复自主循环则随后给予相同组合的研究药物，如有需要随后再给予额外的肾上腺素。主要终点是入院存活；次要终点是自主循环恢复、出院存活、良好的神经功能恢复和1年存活。
总共1442例患者被分配接受肾上腺素和血管加压素联合治疗，1452例患者被分配单独接受肾上腺素治疗。治疗组具有相似的基线特征，只是接受联合治疗的组中男性多于单独接受肾上腺素治疗的组（P = 0.03）。联合治疗组和仅用肾上腺素组在入院存活（20.7%对21.3%；死亡相对风险，1.01；95%置信区间[CI]，0.97至1.05）、自主循环恢复（28.6%对29.5%；相对风险，1.01；95%CI，0.97至1.06）、出院存活（1.7%对2.3%；相对风险，1.01；95%CI，1.00至1.02）、1年存活（1.3%对2.1%；相对风险，1.01；95%CI，1.00至1.02）或出院时良好的神经功能恢复（37.5%对51.5%；相对风险，1.29；95%CI，0.81至2.06）方面无显著差异。
与单独使用肾上腺素相比，在院外心脏骤停的高级心脏生命支持过程中，血管加压素和肾上腺素联合使用并不能改善预后。（ClinicalTrials.gov编号，NCT00127907。）
