Shinada Takuro, Hata Noritake, Kobayashi Nobuaki, Tomita Kazunori, Shirakabe Akihiro, Tsurumi Masafumi, Matsushita Masato, Okazaki Hirotake, Yamamoto Yoshiya, Yokoyama Shinya
The Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Japan.
J Nippon Med Sch. 2013;80(4):287-95. doi: 10.1272/jnms.80.287.
Cardiopulmonary resuscitation and mild therapeutic hypothermia (MTH) have improved neurological outcomes after sudden cardiac arrest, but the factors affecting favorable neurological outcome remain unclear. The aim of this study was to clarify these factors in patients in cardiac arrest treated with MTH.
Forty-six consecutive patients (mean age, 59.4 ± 14.3 years; 37 men and 9 women) who had had cardiogenic cardiac arrest from January 2008 through December 2011, including cases that were and were not shockable, were enrolled in this study, and the factors affecting favorable neurological outcome were retrospectively investigated. The interval from cardiac arrest to cardiopulmonary resuscitation, the return of spontaneous circulation (ROSC), the start of MTH, and the attaining of the target temperature were retrieved from the medical records. The relationship between the neurological outcome and clinical findings, including the causes of cardiac arrest and vital signs before MTH, were also investigated.
Blood pressure and body temperature before MTH were higher, the interval from cardiac arrest to ROSC was shorter, and MTH was started earlier in patients with favorable neurological outcomes than in those with unfavorable outcomes. A multivariate logistic regression model revealed that the presence of prehospital ROSC was predictive of a favorable neurological outcome. In addition, renal failure during MTH occurred more frequently in patients with unfavorable neurological outcomes.
MTH is associated with favorable neurological outcomes after sudden cardiac arrest, including those with non-shockable rhythms, especially in patients with prehospital ROSC.
心肺复苏和轻度治疗性低温（MTH）已改善了心脏骤停后的神经学转归，但影响良好神经学转归的因素仍不明确。本研究的目的是阐明接受MTH治疗的心脏骤停患者的这些因素。
连续纳入2008年1月至2011年12月期间发生心源性心脏骤停的46例患者（平均年龄59.4±14.3岁；男性37例，女性9例），包括可除颤和不可除颤的病例，回顾性调查影响良好神经学转归的因素。从病历中获取心脏骤停至心肺复苏的间隔时间、自主循环恢复（ROSC）、MTH开始时间及达到目标温度的时间。还调查了神经学转归与临床特征之间的关系，包括心脏骤停原因及MTH前的生命体征。
神经学转归良好的患者MTH前的血压和体温较高，心脏骤停至ROSC的间隔时间较短，且MTH开始时间较早。多因素logistic回归模型显示，院前ROSC的存在可预测良好的神经学转归。此外，神经学转归不良的患者MTH期间肾衰竭的发生率更高。
MTH与心脏骤停后良好的神经学转归相关，包括非可除颤心律的患者，尤其是院前有ROSC的患者。
