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心脏骤停复苏后早期的超声心动图左心室收缩功能障碍不能预测死亡率或血管升压药需求。

Echocardiographic left ventricular systolic dysfunction early after resuscitation from cardiac arrest does not predict mortality or vasopressor requirements.

作者信息

Jentzer Jacob C, Chonde Meshe D, Shafton Asher, Abu-Daya Hussein, Chalhoub Didier, Althouse Andrew D, Rittenberger Jon C

机构信息

Divisions of Cardiovascular Diseases and Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.

Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15211, United States.

出版信息

Resuscitation. 2016 Sep;106:58-64. doi: 10.1016/j.resuscitation.2016.06.028. Epub 2016 Jul 1.

Abstract

BACKGROUND/AIMS: Echocardiographic abnormalities are common after resuscitation from cardiac arrest. The association between echocardiographic findings with vasopressor requirements and mortality are not well described. We sought to determine the associations between echocardiographic abnormalities and mortality, vasopressor requirements and organ failure after cardiac arrest.

METHODS

We prospectively evaluated 55 adult subjects undergoing transthoracic echocardiography within 24h after resuscitation from cardiac arrest. We evaluated the association between 2D echocardiographic and Doppler measurements and mortality, Sequential Organ Failure Assessment (SOFA) scores and vasopressor requirements.

RESULTS

Inpatient mortality was 60%. Mean left ventricular ejection fraction (LVEF) was 43.6%; LVEF was <40% in 36% of subjects. None of the measured echocardiographic parameters (including LVEF) was significantly associated with inpatient mortality (all p>0.1). Subjects with LVEF <40% more often had shockable arrest rhythms and patients resuscitated from shockable rhythms had lower mean LVEF (36.2% vs. 52.3%, p=0.001). There was no correlation between markers of right and left ventricular systolic or diastolic function (including LVEF and Doppler parameters) with vasopressor requirements, lactate levels or SOFA scores.

CONCLUSION

Echocardiographic parameters (including LVEF) were not associated with inpatient mortality after cardiac arrest. Vasopressor requirements and organ failure severity were not associated with multiple echocardiographic markers of systolic function.

摘要

背景/目的:心脏骤停复苏后超声心动图异常很常见。超声心动图检查结果与血管升压药需求及死亡率之间的关联尚未得到充分描述。我们试图确定心脏骤停后超声心动图异常与死亡率、血管升压药需求及器官衰竭之间的关联。

方法

我们前瞻性评估了55名成年受试者,这些受试者在心脏骤停复苏后24小时内接受了经胸超声心动图检查。我们评估了二维超声心动图和多普勒测量结果与死亡率、序贯器官衰竭评估(SOFA)评分及血管升压药需求之间的关联。

结果

住院死亡率为60%。平均左心室射血分数(LVEF)为43.6%;36%的受试者LVEF<40%。所测量的超声心动图参数(包括LVEF)均与住院死亡率无显著关联(所有p>0.1)。LVEF<40%的受试者更常出现可电击复律的心律,且从可电击复律心律中复苏的患者平均LVEF较低(36.2%对52.3%,p=0.001)。右心室和左心室收缩或舒张功能指标(包括LVEF及多普勒参数)与血管升压药需求、乳酸水平或SOFA评分之间无相关性。

结论

超声心动图参数(包括LVEF)与心脏骤停后的住院死亡率无关。血管升压药需求及器官衰竭严重程度与多种收缩功能的超声心动图指标无关。

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