治疗性低温对改善院外心脏骤停患者生存率的有效性
Usefulness of Therapeutic Hypothermia to Improve Survival in Out-of-Hospital Cardiac Arrest.
作者信息
Ko Po-Yen, Wang Ling-Ling, Chou Yi-Jiun, Tsai Jeffrey J P, Huang Su-Hua, Chang Chih-Ping, Shiao Yi-Tzone, Lin Jen-Jyh
机构信息
Division of Cardiology, Department of Medicine, China Medical University Hospital.
China Medical University.
出版信息
Acta Cardiol Sin. 2019 Jul;35(4):394-401. doi: 10.6515/ACS.201907_35(4).20190113A.
BACKGROUND
In recent years, therapeutic hypothermia (TH) has been used to improve outcomes in patients with out-of-hospital cardiac arrest (OHCA). Despite these recommendations, many centers are still hesitant to implement such hypothermia protocols. In this study, we assessed the effects of TH for OHCA patients.
METHODS
A total of 58 OHCA patients who had return of spontaneous circulation after OHCA presumed to be due to cardiac causes were enrolled. Twenty-three patients underwent TH, which was performed using a large volume of ice crystalloid fluid infusions in the emergency room and conventional cooling blankets in the ICU to maintain a body temperature of 32-34 °C for 24 hours using a tympanic thermometer. Patients in the control group received standard supportive care without TH. Hospital survival and neurologic outcomes were compared.
RESULTS
There were no significant differences between the groups in patient characteristics, underlying etiologies and disease severity. In the 23 patients who received TH, 17 were alive at hospital discharge. In the 35 patients who received supportive care, only 11 were alive at hospital discharge (73.91% vs. 31.43%, p = 0.0015). Approximately 52% of the patients in the TH group had good neurologic outcomes (12 of 23) compared with the 20% (7 of 35) of the patients in the supportive group (p = 0.01).
CONCLUSIONS
TH can improve the outcomes of OHCA patients. Further large-scale studies are needed to verify our results.
背景
近年来，治疗性低温（TH）已被用于改善院外心脏骤停（OHCA）患者的预后。尽管有这些建议，但许多中心仍对实施此类低温治疗方案犹豫不决。在本研究中，我们评估了TH对OHCA患者的影响。
方法
总共纳入了58例因心脏原因导致OHCA后恢复自主循环的患者。23例患者接受了TH治疗，在急诊室通过大量输注冰晶体液，并在重症监护病房使用传统降温毯，使用鼓膜温度计将体温维持在32-34°C达24小时。对照组患者接受无TH的标准支持治疗。比较两组患者的医院生存率和神经学预后。
结果
两组患者在特征、潜在病因和疾病严重程度方面无显著差异。在接受TH治疗的23例患者中，17例出院时存活。在接受支持治疗的35例患者中，只有11例出院时存活（73.91%对31.43%，p = 0.0015）。TH组约52%的患者有良好的神经学预后（23例中的12例），而支持治疗组为20%（35例中的7例）（p = 0.01）。
结论
TH可改善OHCA患者的预后。需要进一步的大规模研究来验证我们的结果。
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