经连续性肾脏替代治疗实施亚低温的效果及其改善心搏骤停患者神经功能预后的初步疗效观察  

Efficacy of mild hypothermia induced by continuous renal replacement therapy and its preliminary effectiveness in improving neurological outcomes in patients with cardiac arrest

作　　者：徐康敏 陈启江 葛子盛 沈荣荣[2] 陈闯[3] 叶森 陈晨松 胡东军 Xu Kangmin;Chen Qijiang;Ge Zisheng;Shen Rongrong;Chen Chuang;Ye Sen;Chen Chensong;Hu Dongjun(Department of Intensive Care Medicine,the First Hospital of Ninghai,Ningbo 315600,China;Department of Anesthesiology,Yuyao People s Hospital,Ningbo 315400,China;Department of Emergency Medicine,Zhejiang Hospital,Hangzhou 310030,China;Department of Intensive Care Medicine,Zhejiang Provincial People's Hospital,Hangzhou 310014,China;Department of Intensive Care Medicine,the First People's Hospital of Xiangshan,Ningbo 315700,China;Department of Intensive Care Medicine,Yinzhou No.2 Hospital,Ningbo 315000,China)

机构地区：[1]宁海县第一医院重症医学科,宁波315600 [2]余姚市人民医院麻醉科,宁波315400 [3]浙江医院急诊科,杭州310030 [4]浙江省人民医院重症医学科,杭州310014 [5]象山县第一人民医院重症医学科,宁波315700 [6]鄞州区第二医院重症医学科,宁波315000

出　　处：《中国心血管杂志》2025年第1期69-74,共6页Chinese Journal of Cardiovascular Medicine

基　　金：浙江省医药卫生科技计划项目(2022KY1197、2022KY588);宁波市科技计划项目(2021S123)。

摘　　要：目的探讨经连续性肾脏替代治疗(CRRT)实施治疗性亚低温的效果,以及初步观察其改善心搏骤停患者神经功能预后的临床疗效。方法前瞻性、多中心、随机对照研究。连续选取2021年5月1日至2023年8月31日在宁波市内三家综合性医院包括宁海县第一医院、象山县第一人民医院和鄞州区第二医院实施心肺复苏后恢复自主循环的心搏骤停患者共36例,其中男性28例(77.8%)。按随机数字表法分为体表低温组19例和CRRT低温组17例。两组患者在应用常规治疗的基础上,分别应用控温毯仪和CRRT机实施治疗性亚低温,目标体温设置为33℃,达标后维持33℃±0.5℃的温度至少24 h,再以0.25~0.5℃/h速率复温至37℃±0.5℃的正常体温并维持该温度。治疗前,记录患者的一般情况。治疗性亚低温实施期间,记录患者低温诱导期、低温维持期和复温期的数据资料。治疗后1和2 w时,应用格拉斯哥昏迷评分(GCS)和脑功能表现分级(CPC)评估患者的神经功能状态。结果治疗前,两组患者的性别、年龄、心搏骤停原因和时间、心肺复苏时长、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)和序贯器官衰竭评估(SOFA)评分等比较,差异均无统计学意义(均为P>0.05)。治疗性亚低温实施期间,CRRT低温组患者的低温启动时机慢于体表低温组,但差异无统计学意义[(27.6±9.2)min比(23.8±9.9)min,t=-1.203,P=0.237];CRRT低温组患者的降温速率显著快于体表低温组[(3.65±1.28)℃/h比(2.04±0.22)℃/h,t=-5.419,P<0.001],且达标时长显著短于体表低温组[(1.36±0.49)h比(2.38±0.83)h,t=4.427,P<0.001],差异均有统计学意义;两组患者的亚低温维持范围和时长、复温速率和时长基本一致,差异均无统计学意义(均为P>0.05)。治疗后1和2 w时,CRRT低温组患者的GCS评分显著高于体表低温组[1 w:(8.12±4.69)分比(5.11±3.81)分,t=-2.124;2 w:(10.24±5.55)分比(6.47±4.97)分,t=-2.145],且CPC评分显著Objective To explore the efficacy of therapeutic mild hypothermia induced by continuous renal replacement therapy(CRRT)and its preliminary effectiveness in improving neurological outcomes in patients with cardiac arrest.Methods This was a prospective,multicenter,randomized controlled study.A total of 36 patients(28 males,77.8%)with cardiac arrest who obtained spontaneous circulation after cardiopulmonary resuscitation in three general hospitals in Ningbo,including the First Hospital of Ninghai,the First People s Hospital of Xiangshan,and Yinzhou No.2 Hospital,were continuously selected from May 1,2021 to August 31,2023.The patients were randomly assigned to either the surface cooling group(n=19)or the CRRT cooling group(n=17)using a random number table.On the basis of conventional treatment,the two groups received therapeutic mild hypothermia using surface blanket or CRRT machine,respectively.The target body temperature was set at 33℃,and once achieved,it was maintained at 33℃±0.5℃for at least 24 hours.Afterward,the body temperature was gradually rewarmed to 37℃±0.5℃at a rate of 0.25–0.5℃/h and maintained at this normal temperature.Before treatment,the patient s general condition was recorded.During the implementation of therapeutic mild hypothermia,the data of patients hypothermia induction,maintenance,and rewarming were recorded.The Glasgow coma score(GCS)and cerebral performance category(CPC)were used to assess the patients neurological status at 1 and 2 weeks after treatment.Results Before treatment,there were no significant differences in gender,age,cause and duration of cardiac arrest,duration of cardiopulmonary resuscitation,scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)between the two groups(all P>0.05).During the implementation of therapeutic mild hypothermia,the timing of hypothermia initiation in the CRRT cooling group was slower than that in the surface cooling group,but the difference was not statistically significan

关 键 词：心搏骤停 心肺复苏 治疗性亚低温 连续性肾脏替代治疗 神经功能 预后 

分 类 号：R541.78[医药卫生—心血管疾病]