Lindner K H, Dirks B, Strohmenger H U, Prengel A W, Lindner I M, Lurie K G
Department of Anesthesiology and Critical Care Medicine, University of Ulm, Germany.
Lancet. 1997 Feb 22;349(9051):535-7. doi: 10.1016/S0140-6736(97)80087-6.
Studies in animals have suggested that intravenous vasopressin is associated with better vital-organ perfusion and resuscitation rates than is epinephrine in the treatment of cardiac arrest. We did a randomised comparison of vasopressin with epinephrine in patients with ventricular fibrillation in out-of-hospital cardiac arrest.
40 patients in ventricular fibrillation resistant to electrical defibrillation were prospectively and randomly assigned epinephrine (1 mg intravenously; n = 20) or vasopressin (40 U intravenously; n = 20) as primary drug therapy for cardiac arrest. The endpoints of this double blind study were successful resuscitation (hospital admission), survival for 24 h, survival to hospital discharge and neurological outcome (Glasgow coma scale). Analyses were by intention to treat.
Seven (35%) patients in the epinephrine group and 14 (70%) in the vasopressin group survived to hospital admission (p = 0.06). At 24 h, four (20%) epinephrine-treated patients and 12 (60%) vasopressin-treated patients were alive (p = 0.02). Three (15%) patients in the epinephrine group and eight (40%) in the vasopressin group survived to hospital discharge (p = 0.16). Neurological outcomes were similar (mean Glasgow coma score at hospital discharge 10.7 [SE 3.8] vs 11.7 [1.6], p = 0.78).
In this preliminary study, a significantly larger proportion of patients created with vasopressin than of those treated with epinephrine were resuscitated successfully from out-of-hospital ventricular fibrillation and survived for 24 h. Based upon these findings, larger multicentre studies of vasopressin in the treatment of cardiac arrest are needed.
动物研究表明，在治疗心脏骤停时，静脉注射血管加压素相较于肾上腺素，与更好的重要器官灌注及复苏率相关。我们对院外心脏骤停且发生心室颤动的患者进行了血管加压素与肾上腺素的随机对照研究。
40例对电除颤无反应的心室颤动患者被前瞻性随机分配接受肾上腺素（静脉注射1毫克；n = 20）或血管加压素（静脉注射40单位；n = 20）作为心脏骤停的主要药物治疗。这项双盲研究的终点为成功复苏（入院）、存活24小时、存活至出院以及神经学转归（格拉斯哥昏迷量表）。分析采用意向性治疗。
肾上腺素组7例（35%）患者和血管加压素组14例（70%）患者存活至入院（p = 0.06）。24小时时，接受肾上腺素治疗的4例（20%）患者和接受血管加压素治疗的12例（60%）患者存活（p = 0.02）。肾上腺素组3例（15%）患者和血管加压素组8例（40%）患者存活至出院（p = （此处原文有误，应为0.16）。神经学转归相似（出院时格拉斯哥昏迷量表平均评分分别为10.7 [标准误3.8] 与11.7 [1.6]，p = 0.78）。
在这项初步研究中，与接受肾上腺素治疗的患者相比，接受血管加压素治疗的患者从院外心室颤动中成功复苏并存活24小时的比例显著更高。基于这些发现，需要开展更大规模关于血管加压素治疗心脏骤停的多中心研究。
