Gando S, Tedo I
Department of Emergency and Critical Care Medicine, Sapporo City General Hospital, Japan.
Intensive Care Med. 1995 Aug;21(8):636-40. doi: 10.1007/BF01711540.
To determine the changes in neutrophil elastase levels in patients with cardiac arrest occurring outside the hospital and to evaluate the effects of urinastatin on these changes and on the clinical outcomes of the patients.
Prospective study.
The Emergency Department and a general ICU in the tertiary care city hospital.
Of the 40 patients who had an out-of-hospital cardiac arrest, 38 of the cases were randomized into 2 groups, with 2 cases being excluded because of contradiction to protocol. The control and urinastatin groups consisted of 20 and 18 patients, respectively.
Control patients were treated by standard cardiopulmonary resuscitation (CPR) procedures. Patients in the urinastatin group were administered a 100,000 U dose of urinastatin immediately after arrival at the Emergency Department and three 100,000 U doses at 8 h intervals, within the first 24 h after resuscitation.
At the time of arrival at the emergency room (before administration of urinastatin), and at 30 min, 60 min, and 24 h after, the plasma levels of neutrophil elastase and blood gas levels were determined. Concerning the baseline characteristics of patients, causes of cardiac arrest, time duration of pre-hospital care and treatments given during CPR, there was no difference detected between the control and urinastatin groups. In addition, the pH and PaO2 values showed no differences. Neutrophil elastase values had already increased by the time of arrival and continued to do so until 60 min; at 24 h after admission, markedly higher values were obtained. These values were significantly higher in the non-resuscitated cases than in the resuscitated ones. Administration of urinastatin significantly suppressed this increase at 24 h, but did not improve the clinical outcomes, including resuscitation rate and survival rate.
Accompanying cardiopulmonary arrest and resuscitation, neutrophils are activated and elastase is released. Elevated elastase level is associated with poorer prognosis. Urinastatin can suppress the release of elastase, when utilized at the dose described in this study, did not improve the clinical outcomes of patients who had suffered an out-of-hospital cardiac arrest.
确定院外心脏骤停患者中性粒细胞弹性蛋白酶水平的变化，并评估乌司他丁对这些变化及患者临床结局的影响。
前瞻性研究。
三级医疗城市医院的急诊科和综合重症监护病房。
在40例院外心脏骤停患者中，38例被随机分为2组，2例因不符合方案被排除。对照组和乌司他丁组分别有20例和18例患者。
对照组患者采用标准心肺复苏（CPR）程序治疗。乌司他丁组患者在抵达急诊科后立即给予100,000 U剂量的乌司他丁，并在复苏后的头24小时内每隔8小时给予3次100,000 U剂量。
在抵达急诊室时（给予乌司他丁前）以及之后的30分钟、60分钟和24小时，测定中性粒细胞弹性蛋白酶的血浆水平和血气水平。关于患者的基线特征、心脏骤停原因、院前护理时间和CPR期间给予的治疗，对照组和乌司他丁组之间未检测到差异。此外，pH值和PaO2值也无差异。中性粒细胞弹性蛋白酶值在抵达时就已升高，并持续升高直至60分钟；入院24小时后，获得的值明显更高。这些值在未复苏的病例中显著高于复苏的病例。给予乌司他丁在24小时时显著抑制了这种升高，但未改善临床结局，包括复苏率和生存率。
伴随心肺骤停和复苏，中性粒细胞被激活并释放弹性蛋白酶。弹性蛋白酶水平升高与较差的预后相关。乌司他丁可抑制弹性蛋白酶的释放，在本研究所述剂量下使用时，并未改善院外心脏骤停患者的临床结局。
