Patrick W D, Freedman J, McEwen T, Light R B, Ludwig L, Roberts D
Department of Critical Care Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Am J Respir Crit Care Med. 1995 Aug;152(2):519-23. doi: 10.1164/ajrccm.152.2.7633701.
The beneficial effect of epinephrine has been attributed to its alpha-adrenergic properties. The present study was designed to compare the effects of epinephrine and methoxamine in witnessed cardiac arrests. Consecutive, witnessed cardiac-arrest victims presenting to the emergency room or from the inpatient population of our institution were enrolled in this study. Patients were randomized to receive either epinephrine (2 mg bolus followed by 2 mg every 4 min) or methoxamine (40 mg bolus followed after 4 min by 40 mg) in a blind design. Patients were followed prospectively for survival and neurologic outcome. A total of 199 patients were randomized into the study, but 54 had to be retrospectively dropped from analysis for failure to comply with the study protocol. Of the 145 patients remaining, 77 received methoxamine (M) and 68 epinephrine (E). There was no difference in rate of successful resuscitation (42% versus 53%, M versus E, respectively), or in neurologic outcome as measured by the Glasgow-Pittsburgh Coma Score (GPCS). This study failed to demonstrate any difference in the rate of initial resuscitation, survival to discharge from the hospital, or neurologic status with methoxamine as opposed to epinephrine in the setting of cardiac arrest.
肾上腺素的有益作用归因于其α-肾上腺素能特性。本研究旨在比较肾上腺素和甲氧明在目击心脏骤停中的效果。本研究纳入了连续的、在我院急诊室就诊或住院的目击心脏骤停患者。患者被随机分组，采用盲法设计，分别接受肾上腺素（2 mg推注，随后每4分钟2 mg）或甲氧明（40 mg推注，4分钟后再推注40 mg）。对患者进行前瞻性随访，观察生存情况和神经功能转归。共有199例患者被随机纳入研究，但54例因未遵守研究方案而不得不从分析中被追溯剔除。在剩余的145例患者中，77例接受了甲氧明（M组），68例接受了肾上腺素（E组）。成功复苏率（分别为42%对53%，M组对E组）以及用格拉斯哥-匹兹堡昏迷评分（GPCS）衡量的神经功能转归方面均无差异。本研究未能证明在心脏骤停情况下，与肾上腺素相比，甲氧明在初始复苏率、出院生存率或神经功能状态方面存在任何差异。
