心肺复苏过程中早期应用地西泮的脑保护作用研究  

Neuroprotective effect of early intravenous diazepam during cardiopulmonary resuscitation

作　　者：徐震亚[1] 郭铁[1] 徐娜[1] 李宏宾[1] 冯敏[1] 孙荣青[1] XU Zhenya;GUO Tie;XU Na;LI Hongbin;FENG Min;SUN Rongqing(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2020年第15期1312-1317,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省教育厅重点科研项目(编号:19A320009)。

摘　　要：目的观察心肺复苏过程中早期静脉推注地西泮对脑功能保护的作用。方法回顾性分析郑州大学第一附属医院2014-01—2019-12的住院患者中给予心肺复苏后转入外科ICU且存活超过72 h的患者165例。随机分为试验组和对照组。对照组按照美国心脏病学会(AHA)制定的心肺复苏指南进行基础心肺复苏及高级心肺复苏。试验组在对照组治疗的基础上,心肺复苏开始后,静脉推注肾上腺素前或同时推注10 mg地西泮,若复苏时间超过15 min,可再次推注10 mg地西泮。统计分析2组之间72 h GCS(E+M)评分,30 d或出院时可预计的GOS评分,复苏后72 h内有无癫痫、高热、肾损伤,24 h内的APACHEⅡ评分,复苏成功后乳酸值及6 h乳酸清除率,机械通气时间等有无差异。结果2组患者临床基本信息无明显差异,72 h GCS评分、72 h内癫痫发生率、24 h内APACHEⅡ评分、6 h乳酸清除率差异有统计学意义(P<0.05)。30 d GOS评分差异无统计学意义(P>0.05)。通过二元Logistic回归分析,地西泮应用是72 h GCS评分的保护因素。结论心肺复苏过程中早期使用地西泮,有利于改善患者72 h的GCS评分,可能具有脑功能保护作用,但对最终GOS评分无明显改善。Objective To observe the effect of early intravenous bolus diazepam on brain function protection during cardiopulmonary resuscitation.Methods A retrospective analysis of 165 patients who were transferred to surgical ICU after cardiopulmonary resuscitation from the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2019 and survived for more than 72 hours.Randomly divided into experimental group and control group.The control group performed basic cardiopulmonary resuscitation and advanced cardiopulmonary resuscitation in accordance with the cardiopulmonary resuscitation guidelines developed by the American College of Cardiology(AHA).In the experimental group,on the basis of treatment in the control group,after cardiopulmonary resuscitation began,10 mg diazepam was injected before or simultaneously with intravenous epinephrine.If the recovery time exceeds 15 minutes,10 mg diazepam can be injected again.Statistical analysis of the 72-hour GCS(E+M)score between the two groups,the GOS score that can be predicted at 30 days or discharge,the presence or absence of epilepsy,high fever,and kidney injury within 72 hours after resuscitation,and the APACHEⅡscore within 24 hours.There was no difference in post-lactic acid value,6-hour lactic acid clearance,and mechanical ventilation time.Results There was no significant difference in the basic clinical information between the two groups.The 72-hour GCS score,72-hour epilepsy incidence,24-hour APACHEⅡscore,and 6-hour lactate clearance rate were statistically significant(P<0.05).There was no statistically significant difference in GOS score at 30 days(P>0.05).Through binary Logistic regression analysis,diazepam applied the protective factors of 72 h GCS score.Conclusion The early use of diazepam during cardiopulmonary resuscitation is helpful to improve the patient's 72-hour GCS score.It may have a protective effect on brain function,but it does not significantly improve the final GOS score.

关 键 词：心肺复苏 地西泮 脑保护 GCS评分 GOS评分 

分 类 号：R605.974[医药卫生—急诊医学]