院外心脏疾病患者中，根据初始体温比较中度低温与正常体温对生存结局的影响：一项全国性观察性研究
Effects of moderate hypothermia versus normothermia on survival outcomes according to the initial body temperature in out-of-hospital cardiac patients: A nationwide observational study.
作者信息
Kim Jong Hwan, Park Jeong Ho, Shin Sang Do, Song Kyoung Jun, Hong Ki Jeong, Kim Tae Han, Kim Ki Hong
机构信息
Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
出版信息
Resuscitation. 2020 Jun;151:157-165. doi: 10.1016/j.resuscitation.2020.04.003. Epub 2020 Apr 12.
AIM
We aimed to investigate whether the effect of moderate hypothermia compared to normothermia on survival outcomes after out-of-hospital cardiac arrest (OHCA) patients who underwent targeted temperature management (TTM) differed between patients with and without initial spontaneous hypothermia.
METHODS
We used data from a nationwide OHCA database collected between 2016 and 2017. Adult patients with OHCA of presumed cardiac aetiology who underwent TTM were included. Moderate hypothermia was defined as a target temperature of TTM < 35.5 °C. Initial hypothermia was defined as the measured temperature before starting TTM < 35.5 °C. Endpoints were survival to discharge and good neurological recovery (CPC 1 or 2). We compared outcomes between moderate hypothermia vs. normothermia using multivariable logistic regression with an interaction term between target temperature of TTM and initial spontaneous hypothermia.
RESULTS
Of the 744 patients, 628 (84.4%) underwent moderate hypothermia. Initial spontaneous hypothermia was observed in 28.5% and 25.0% in the moderate hypothermia and normothermia groups, respectively. There was no significant difference in survival to discharge between moderate hypothermia and normothermia (57.2% vs 62.9%, p = 0.248). The initial spontaneous hypothermia group showed poorer survival than the initial non-hypothermia group (41.8% vs 64.4%, p < 0.001). In the interaction model, AOR (95% CI) for survival to discharge of moderate hypothermia was 3.51 (1.33-9.25) in patients with initial spontaneous hypothermia and 0.49 (0.27-0.89) in patients without initial spontaneous hypothermia.
CONCLUSION
The effect of moderate hypothermia was modified by the initial temperature of OHCA survivors who underwent TTM. The positive effect of moderate hypothermia was increased in patients with initial spontaneous hypothermia.
目的
我们旨在研究与正常体温相比，中度低温对接受目标温度管理（TTM）的院外心脏骤停（OHCA）患者生存结局的影响在初始有或无自发低温的患者之间是否存在差异。
方法
我们使用了2016年至2017年期间收集的全国性OHCA数据库中的数据。纳入了因推测为心脏病因导致OHCA且接受TTM的成年患者。中度低温定义为TTM的目标温度<35.5°C。初始低温定义为开始TTM前测得的温度<35.5°C。终点为出院生存和良好的神经功能恢复（脑功能分类[CPC] 1或2）。我们使用多变量逻辑回归并结合TTM目标温度与初始自发低温之间的交互项，比较了中度低温与正常体温之间的结局。
结果
在744例患者中，628例（84.4%）接受了中度低温治疗。中度低温组和正常体温组中初始自发低温的发生率分别为28.5%和25.0%。中度低温与正常体温之间出院生存率无显著差异（57.2%对62.9%，p = 0.248）。初始自发低温组的生存率低于初始无低温组（41.8%对64.4%，p<0.001）。在交互模型中，初始有自发低温的患者中，中度低温出院生存的调整后比值比（AOR，95%置信区间）为3.51（1.33 - 9.25），初始无自发低温的患者中为0.49（0.27 - 0.89）。
结论
接受TTM的OHCA幸存者的初始温度改变了中度低温的效果。初始有自发低温的患者中，中度低温的积极效果增强。
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