持续应用神经肌肉阻滞剂改善心脏骤停后综合征患者预后的临床研究  

Clinical study of the prognosis of the patients with post cardiac arrest syndrome after continuous application of neuromuscular blocker

作　　者：何囡囡 罗延年[1] 曹雯[1] 高雪花[1] 关银[1] 王雪婷[1] 李培杰[1] 王锐[1] He Nan-nan;Luo Yan-nian;Cao Wen;Gao Xue-hua;Guan Yin;Wang Xue-ting;Li Pei-jie;Wang Rui(ICU,Lanzhou Universily Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院重症医学科,甘肃兰州730030

出　　处：《中国急救医学》2020年第7期606-609,共4页Chinese Journal of Critical Care Medicine

基　　金：甘肃省卫生行业科研计划项目(GSWSKY-2015-62)。

摘　　要：目的心肺复苏(CPR)后患者接受治疗性低温可改善预后,而在治疗性低温时常应用神经肌肉阻滞剂预防寒战.本研究试图明确神经肌肉阻滞剂是否与改善院内心脏骤停患者预后相关.方法本研究为回顾性对照观察研究,研究对象为入住我院成人ICU、年龄≥18岁的心脏骤停昏迷患者.共有283例患者入选,根据24 h内是否持续应用神经肌肉阻滞剂分为两组,持续应用组67例,未持续应用组216例.主要观察终点为两组患者出院存活与神经功能完整性,次要终点为氧合指数和血乳酸改善.结果持续应用组患者的出院存活率为52.2%,未持续应用组患者的出院存活率为19.0%(P<0.05).与未持续应用组比较,持续应用组神经功能有明显改善(19%vs.64%,P<0.05).多变量校正后显示,神经肌肉阻滞剂与患者存活及脑功能改善呈正相关(校正OR值7.01,95%CI 1.50~32.35和校正OR值1.29,95%CI 1.06~3.59).同时,持续应用组乳酸清除率在12h及24h也有明显改善(P<0.05).两组患者氧合指数比较差异无统计学意义(P>0.05).结论在CPR后第一个24 h持续应用神经肌肉阻滞剂与改善存活及脑功能相关,同时也可改善乳酸清除率.Objective Therapeutic hypothermia can improve the outcome of patients after cardiopulmonary resuscitation.Neuromuscular blockers are often used in therapeutie hypothermia to prevent shivering.Our objective was to determine whether neuromuscular blockade was associated with improved outcomes in post cardiac arrest syndrome patients.Methods This was a retrospective observational study.283 comatose adult patients(≥18 years)with cardiac arrest in MICU of Lanzhou University Second Hospital were included,and were divided into two groups according to whether neuromuscular blockade were continuously used within 24 hours,67 patients with 24-hour sustained neuromuscular blockade and 216 patients without sustained neuromuscular blockade.The primary outcomes were in-hospital survival and functional stalus at hospital discharge.Secondary outcomes were the evolution of oxygenation index and the change in lactate.Results In the patients with 24-hour sustained neuromuscular blockade,the crude survival rate was 52.2%compared with 19.0%in the patients without sustained neuromuscular blockade(P<0.05).There was a trend toward improved functional outcome with neuromuscular blockade(19%vs.64%,P<0.05).After multivariable adjustment,neuromuscular blockade was associated with survival and improved funetional outcome(adjusted OR 7.01,95%CI 1.50-32.35 and adjusted OR 1.29,95%CI 1.06-3.59).Sustained neuromuscular blockade was associated with improved lactate clearance in 12 h and 24 h(P<0.05).There was no significant difference in oxygenation index between the two groups(P>0.05).Conclusion We find that early neuromuseular blockade for a 24 h period is associated with an inereased probability of survival and improved functional outcome.Secondarily,we find that,sustained neuromuscular blockade is associated with improved lactate clearance.

关 键 词：神经肌肉阻滞剂 心脏骤停后综合征 预后 

分 类 号：R459.7[医药卫生—急诊医学]