温州地区开展亚低温治疗对心肺复苏后昏迷患者预后影响的研究  

Prognosis of hypothermia treatment for coma patients after cardiopulmonary resuscitation in Wenzhou

作　　者：雷远丽 卢颖如[1] 陈寿权[1] 李章平[1] 李惠萍[1] 许华清 孙来芳[2] 尤荣开 陈新国 阮战伟[5] 刘晓[6] 金细众 陈朴 徐良志 黄增峰 吴小明 Lei Yuanli;Lu Yingru;Chen Shouquan;Li Zhangping;Li Huiping;Xu Huaqing;Sun Laifang;You Rongkai;Chen Xinguo;Ruan Zhanwei;Liu Xiao;Jin Xizhong;Chen Pu;Xu Liangzhi;Huang Zengfeng;Wu Xiaoming(Department of Emergency,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Emergency,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Critical Care Medicine,Wenzhou Central Hospital,Wenzhou 325000,China;Department of Emergency,Wenzhou People＇s Hospital,Wenzhou 325041,China;Department of Emergency,Ruian People＇s Hospital,Wenzhou 325200,China;Department of Emergency,Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,China;Department of Critical Care Medicine,Wenzhou Hospital of Integrated Chinese and Western Medicine,Wenzhou 325000,China;Department of Critical Care Medicine,Yueqing People＇s Hospital,Yueqing 325600,China;Department of Critical Care Medicine,People＇s Hospital of Pingyang,Wenzhou 325400,China;Department of Emergency,Cangnan Hospital of Traditional Chinese Medicine,Wenzhou 325800,China;Department of Emergency,Wencheng People＇s Hospital,Wenzhou 325300,China)

机构地区：[1]温州医科大学附属第一医院急诊科,浙江温州325000 [2]温州医科大学附属第二医院急诊科,浙江温州325027 [3]温州市中心医院重症医学科,浙江温州325000 [4]温州市人民医院急诊科,浙江温州325041 [5]瑞安市人民医院急诊科,浙江温州325200 [6]温州市中医院急诊科,浙江温州325000 [7]温州中西医结合医院重症医学科,浙江温州325000 [8]乐清市人民医院重症医学科,浙江乐清325600 [9]平阳县人民医院重症医学科,浙江温州325400 [10]苍南县中医院急诊科,浙江温州325800 [11]文成县人民医院急诊科,浙江温州225300

出　　处：《中华危重症医学杂志（电子版）》2018年第5期304-309,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省科技厅项目(2013T301-13)

摘　　要：目的探讨温州地区推广亚低温治疗(HT)对心肺复苏(CPR)后昏迷患者预后的影响。方法温州地区成立1家推广示范基地及10家推广基地,自2014年1月至2016年12月,对CPR后昏迷患者实施HT。记录所有患者亚低温治疗相关信息,比较推广期间3年患者ICU出院存活率、神经功能恢复良好率及严重致残率。结果推广期间共对133例CPR后昏迷患者实施HT,推广第1年、第2年、第3年分别为28、46、59例。推广第1年、第2年、第3年达到目标体温时间[8.0(3.0,18.8)、10.0(4.8,20.0)、6.0(2.0,12.0)h]、药物使用率[17(60.7%)、43(93.5%)、42(71.2%)]及肌松剂使用率[0(0%)、1(2.2%)、13(22.0%)]比较,差异均有统计学意义(H=10.475,P=0.005;χ~2=12.250,P=0.002;χ~2=17.647,P <0.001)。推广期间ICU出院存活率呈现逐年上升趋势,严重致残率呈现逐年下降趋势;但3年间比较差异均无统计学意义(χ~2=2.537,P=0.281;χ~2=0.308,P=0.857)。推广3年间神经功能恢复良好率比较,差异有统计学意义(χ~2=12.232,P=0.002),且推广第3年较第1年及第2年神经功能恢复良好率更高[16 (27.1%)、1 (3.6%)、3(6.5%),P均<0.017]。结论规范化的HT能有效地促进神经功能恢复。Objective To analyze the prognosis of hypothermia treatment （HT） for coma patients after cardiopulmonary resuscitation （CPR） in Wenzhou. Methods A implementation demonstration base and 10 implementation bases were established in Wenzhou. HT was implemented in patients with coma after CPR from January 2014 to December 2016. The data of HT were recorded. The survival rate of ICU discharge, recovery rate of neurological functions and severe disability rate in the 3-year implementation period were compared. Results In the implementation period, 133 coma patients after CPR were implemented TH. Respectively, 28, 46 and 59 cases were implemented in the first, second and third years. Time to target temperature [8.0 （3.0, 18.8）, 10.0 （4.8, 20.0）, 6.0 （2.0, 12.0） h], and rates of drug use [17 （60.7%）, 43 （93.5%）, 42 （71.2%）] and muscle relaxant use [0 （0%）, 1 （2.2%）, 13 （22.0%）] were significantly different in the first, second and third years （H = 10.475, P = 0.005; χ^2 = 12.250, P = 0.002; χ^2 = 17.647, P 〈 0.001）. The survival rate of ICU discharge presented an upward trend, and the severe disability rate showed an downward trend year by year. However, there were no significant differences in above indicators （ χ^2 = 2.537, P = 0.281; χ^2 = 0.308, P = 0.857） during the implementation period. The recovery rate of neurological functions during the implementation period was significantly ditterent （χ^2 = 12.232, P= 0.002）; it was higher in the third year than in the first and second years [16 （27.1%）, 1 （3.6%）, 3 （6.5%）, both P〈 0.017）. Conclusion The standardized HT can significantly improve favorable neurological recovery.

关 键 词：心肺复苏术 昏迷 亚低温 目标体温管理 心脏骤停 

分 类 号：R459.7[医药卫生—急诊医学]