纳洛酮在成人心脏骤停后综合征患者治疗中的应用  

Application of naloxone in the treatment of adult patients with post-cardiac arrest syndrome

作　　者：冯玉平 吴得安 李源 何振东 王世琪 宋苗苗 Feng Yuping;Wu De′an;Li Yuan;He Zhendong;Wang Shiqi;Song Miaomiao(Emergency Department,the Third People′s Hospital of Gansu Province,Lanzhou 730020,China)

机构地区：[1]甘肃省第三人民医院急诊科,甘肃兰州730020 [2]甘肃省第三人民医院内科,甘肃兰州730020 [3]甘肃省第三人民医院重症医学科,甘肃兰州730020 [4]甘肃省第三人民医院骨科,甘肃兰州730020

出　　处：《中国急救医学》2025年第4期349-353,共5页Chinese Journal of Critical Care Medicine

基　　金：甘肃省科技计划项目(22JR11RA087,22JR5RA734)。

摘　　要：目的 观察纳洛酮对心脏骤停后综合征(PCAS)患者治疗效果的影响。方法 选择2019年5月至2022年4月甘肃省第三人民医院心脏骤停(CA)行心肺复苏(CPR)后自主循环恢复(ROSC)的成人PCAS患者52例进行研究。所有患者在CA后立即行高质量胸外按压,同时气管插管连接呼吸机支持通气,建立静脉通道,注射肾上腺素,同步进行输液、心电监测。ROSC后,随机分为对照组26例(采用常规抢救治疗)和观察组26例(常规治疗的基础上联合使用纳洛酮),比较两组患者给药后18~24 h呼吸和意识恢复情况、中心静脉血氧饱和度(S_(CV)O_(2))、氧输送(DO 2)、血乳酸与β-内啡肽(β-EP)水平变化,并观察急救后24、72 h的格拉斯哥昏迷评分(GCS)。结果 观察组分别有15例和11例患者在18~24 h恢复自主呼吸和意识状态,对照组仅有10例恢复。与对照组相比,观察组患者恢复呼吸与意识的时间明显缩短(P<0.05),S_(CV)O_(2)和DO _(2)升高幅度更加明显(P<0.05),血乳酸及β-EP水平明显下降(P<0.05)。此外,观察组患者24 h与72 h的GCS评分也较对照组更高。结论 对于PCAS患者在常规治疗基础上使用纳络酮静脉注射,可缩短患者自主呼吸与意识恢复时间,可能与其改善脑组织氧合、降低血浆β-EP水平等有关。Objective To observe the effect of naloxone on the treatment of patients with post-cardiac arrest syndrome(PCAS).Methods A total of 52 adult PCAS patients with cardiac arrest(CA)who had return of spontaneous circulation(ROSC)after cardiopulmonary resuscitation(CPR)in the Third People′s Hospital of Gansu Province from May 2019 to April 2022 were selected.All the patients underwent high-quality chest compressions immediately after CA.At the same time,tracheal intubation was connected to a ventilator to support ventilation,and an intravenous channel was established to inject adrenaline,and the infusion and ECG monitoring were performed simultaneously.After ROSC,they were randomly divided into control group(26 cases,treated with routine therapy)and observation group(26 cases,treated with routine therapy combined with naloxone).The recovery of respiration and consciousness,central venous oxygen saturation(S_(CV)O_(2)),oxygen delivery(DO 2),blood lactic acid andβ-endorphin(β-EP)levels were compared between the two groups 18-24 h after administration.In addition,Glasgow coma scale(GCS)were observed 24 h and 72 h after first aid.Results In the observation group,15 and 11 patients recovered spontaneous breathing and regained consciousness or improved during the observation period of 18-24 h,respectively,while only 10 patients in the control group recovered.Compared with the control group,the recovery time of respiration and consciousness in the observation group was significantly shortened(P<0.05),the increase of S_(CV)O_(2) and DO _(2) was more significant(P<0.05),and the indexes of blood lactic acid andβ-EP were significantly decreased(P<0.05).In addition,the 24-hour and 72-hour GCS scores of the observation group were also higher than those of the control group.Conclusions For the emergency rescue of PCAS patients,the use of naloxone by intravenous injection on the basis of conventional treatment can shorten the patient′s recovery time of spontaneous breathing and consciousness,which may be related to the improv

关 键 词：心肺脑复苏 心脏骤停后综合征 纳洛酮 中心静脉血氧饱和度 氧输送 血乳酸 Β内啡肽 格拉斯哥昏迷评分 

分 类 号：R47[医药卫生—护理学]