Vukmir R B, Bircher N, Safar P
Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh Medical Center, PA 15213-2582, USA.
Am J Emerg Med. 1996 Mar;14(2):192-206. doi: 10.1016/S0735-6757(96)90133-3.
The routine use of sodium bicarbonate in patients with cardiac arrest has been discouraged, with the benefit of outcome evaluation. Current recommendations include an elaborate stratification of circumstances in which bicarbonate is to be used. The physiological and clinical aspects of bicarbonate administration during cardiopulmonary resuscitation in animal and human studies were reviewed. The onset of significant acidemia or alkalemia is associated with adverse system specific effects. The administration of bicarbonate may mitigate the adverse physiological effects of acidemia, improve response to exogenously administered vasopressor agents, or simply increase venous return due to an osmolar effect, resulting in increased coronary perfusion pressure. Likewise, bicarbonate may have adverse effects in each of these areas. The preponderance of evidence suggests that bicarbonate is not detrimental and may be helpful to outcome from cardiac arrest. An objective reappraisal of the empirical use of bicarbonate or other buffer agents in the appropriate "therapeutic window" for cardiac patients may be warranted.
心脏骤停患者常规使用碳酸氢钠已不被提倡，需对其预后益处进行评估。当前建议包括对使用碳酸氢钠的情况进行详细分层。回顾了动物和人体研究中心肺复苏期间给予碳酸氢钠的生理和临床方面。显著酸血症或碱血症的发生与特定系统的不良影响相关。给予碳酸氢钠可能减轻酸血症的不良生理影响，改善对外源性血管加压药的反应，或仅仅由于渗透作用增加静脉回流，从而导致冠状动脉灌注压升高。同样，碳酸氢钠在这些方面可能也有不良影响。大量证据表明，碳酸氢钠并非有害，可能有助于改善心脏骤停的预后。或许有必要对心脏病患者在适当的“治疗窗”内经验性使用碳酸氢钠或其他缓冲剂进行客观重新评估。
