联合针刺救治院内心脏骤停疗效的回顾性分析  

Efficacy of combined acupuncture in the treatment of in-hospital cardiac arrest:a retrospective analysis of 120 cases

作　　者：曾瑞峰 钟悦嘉 陈百坚 李冬莉 李尊江 陈国聪 徐军[2] 丁邦晗 ZENG Ruifeng;ZHONG Yuejia;CHEN Baijian;LI Dongli;LI Zunjiang;CHEN Guocong;XU Jun;DING Banghan(Department of Emergency,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Provincial Hospital of Chinese Medicine,Guangdong Provincial Key Laboratory of Research on Emergency in TCM,Guangzhou,510120,China;Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College)

机构地区：[1]广州中医药大学第二附属医院(广东省中医院)急诊科广东省中医急症研究重点实验室,广州510120 [2]中国医学科学院北京协和医院急诊科

出　　处：《临床急诊杂志》2024年第11期561-567,共7页Journal of Clinical Emergency

基　　金：广东省基础与应用基础研究基金自然科学基金-面上项目(No:2021A1515012224);广东省中医院中医药科学技术研究专项资助(No:2022MS12);广东省中医急症研究重点实验室(No:2023B1212060062)。

摘　　要：目的:探讨联合针刺干预院内心脏骤停(in-hospital cardiac arrest,IHCA)患者临床疗效,以提供对IHCA中西医结合治疗策略的理论依据。方法:对广东省中医院急诊乌斯坦因登记模式数据库进行回顾性分析,选择2013年10月—2021年9月的IHCA为研究对象,根据纳入排除标准筛选出120例患者,根据是否进行针刺干预分为针刺组以及非针刺组。提取一般信息,基础疾病、抢救情况等,以自主循环恢复(return of spontaneous circulation,ROSC)成功率、ROSC维持时间、神经功能评价为主要指标,以实验室指标、危重症评分、28 d死亡率等为次要指标。结果:针刺组ROSC成功率为65.6%,与非针刺组(43.2%)比较,差异有统计学意义(P<0.05)。针刺组与非针刺组ROSC维持时间方面比较[≤20 min:2例(9.5%)vs.9例(23.7%),20 min~24 h:13例(61.9%)vs.16例(42.1%),>24 h:6例(28.6%)vs.13例(34.2%)],差异无统计学意义(P>0.05)。以28 d为观察终点进行生存分析,针刺组的平均生存天数为(3.226±1.242) d(95%CI:0.791~5.661 d),非针刺组的平均生存天数为(2.352±0.692) d(95%CI:0.996~3.709 d)。Kaplan-Meier生存分析提示两组的生存曲线相同,差异无统计学意义(χ^(2)=3.025,P=0.081)。两组各个时间点的其他指标,如血流动力学指标、血常规、血气分析、肝肾凝血功能、危重评分及器官功能支持手段等进行比较,均差异无统计学意义(均P>0.05)。结论:联合针刺救治IHCA无严重不良事件及负性结果,具有更高ROSC成功率,更稳定的ROSC比例的优势。这可能与针刺对ROSC早期的血流动力学的稳定作用有关,有一定的探索价值。Objective:To explore the clinical efficacy of combined acupuncture intervention for patients with in-hospital cardiac arrest(IHCA) to provide a theoretical basis for the integrated Chinese and Western medicine treatment strategy for IHCA.Methods:A retrospective analysis was performed on the emergency Ustein registration model database of the Guangdong Provincial Hospital of Chinese Medicine.IHCA patients were selected as the research subjects from October 2013 to September 2021.According to the inclusion and exclusion criteria,120 patients were screened and divided into an acupuncture group and a non-acupuncture group to determine whether or not acupuncture intervention was performed.General information,underlying diseases,and rescue conditions were extracted.The success rate of return of spontaneous circulation(ROSC),ROSC maintenance time,and neurological function evaluation were used as the primary outcomes.In contrast,the laboratory indicators,critical illness scores,and 28-day mortality were secondary outcomes.Results:The ROSC success rate between the two groups(65.6% in the acupuncture group vs.43.2% in the non-acupuncture group) was significantly different(P<0.05).The comparison of ROSC maintenance time between the two groups was:≤20 min in 2(9.5%):9(23.7%),20 min-24 h in 13(61.9%):16(42.1%),and>24 h in 6(28.6%):13(34.2%),which was not statistically significant(P>0.05).Survival analysis was performed with 28 days as the observation endpoint.The average survival days in the acupuncture group were(3.226±1.242)days(95%CI:0.791-5.661),and the non-acupuncture group were(2.352±0.692)days(95%CI:0.996-3.709).Kaplan-Meier survival analysis showed that the survival curves of the two groups were the same(χ~2=3.025,P=0.081).There was no statistical significance in other indicators at each time point between the two groups,such as hemodynamic indicators,blood routine,blood gas analysis,liver and kidney coagulation function,critical score and organ function support measures(all P>0.05).Conclusion:Combined acupunctur

关 键 词：心脏骤停 院内心脏骤停 心肺脑复苏 针刺 生存分析 

分 类 号：R541.7[医药卫生—心血管疾病]