中国急诊医生对心脏骤停后脑保护认知及实践现况调查  

The national survey on the awareness and practice of neurological protection in the patients following cardiac arrest among emergency physicians in China

作　　者：杜兰芳[1] 郑康[1] 冯璐[1] 马青变[1] Du Lan-fang;Zheng Kang;Feng Lu;Ma Qing-bian(Emergency Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院急诊科,北京100191

出　　处：《中国急救医学》2022年第10期845-849,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的了解急诊医生心脏骤停患者脑保护的认知和实践情况。方法通过问卷调查的方式进行,在全国范围内随机选取75家医院,参研医院所有的急诊科医生均参与调查研究。结果共有1473名受访者参与研究,应答率为92.1%。89.4%受访者认为目标温度管理(target temperature management,TTM)有助于改善心脏骤停患者的神经功能,但仅有15.5%的急诊科及27.8%的受访者在临床实践中实施过TTM。对于理论上有脑保护作用,但目前缺乏相关证据支持的药物和措施,绝大多数受访者认为有脑保护作用并应用于临床实践中,应用最为普遍的三磷酸腺苷(85.9%)、减轻脑水肿的药物(73.5%)、自由基清除剂(70.8%)、营养神经药物(66.4%)、高压氧治疗(60.0%)及线粒体保护剂(45.6%)。结论急诊医生对TTM认知程度有很大改观,但实践情况仍然不理想,临床上更多选择理论上有保护作用但目前尚无确切证据的措施。Objective To investigate the current awareness and practice of neuro-protective interventions in the patients following cardiac arrest(CA)among emergency physicians.Methods A questionnaire was distributed to 1600 emergency physicians in 75 hospitals which were selected randomly from China between January 2018 and July 2018.All emergency physicians of selected hospitals participated in the study.Results 92.1%respondents fulfilled the survey.89.4%of respondents believed that target temperature management(TTM)could improve the neurological outcomes of CA patients,but only 15.5%of the departments and 27.8%of the respondents had implemented TTM in clinical practice.Other interventions including use of adenosine triphosphate,dehydration medicine,free radical scavengers,neurotrophic drugs,hyperbaric oxygen therapy,and mitochondrial protectors were considered to reduce brain damage by 85.9%,73.5%,70.8%,66.4%,60.0%,45.6%respondents respectively and they were more likely to use these interventions in clinical practice.Conclusions TTM had been understood but not well performed in practice by emergency physicians.They were more likely to use interventions which had neuro-protective mechanism but limited evidence.

关 键 词：心脏骤停 心肺复苏 脑保护 目标温度管理 

分 类 号：R459.7[医药卫生—急诊医学]