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JAMA:不支持成年患者院内心脏骤停的早期气管插管!

2017-01-29 MedSci MedSci原创

气管插管在成人院内心脏骤停时很常见,但在这种情况下气管插管与存活之间的关联知之甚少。近期,一项发表在JAMA杂志上的文章进行了一项研究,以确定在成人院内心脏骤停的气管插管是否与存活至出院相关。此项研究对从2000年1月至2014年12月期间住院心脏骤停的成年患者进行观察性队列研究,包括在获得指南-复苏注册表(一个美国的医院心脏骤停的多中心登记)。排除标准为在心脏骤停时已经有侵入性气道的患者。研究暴

气管插管在成人院内心脏骤停时很常见,但在这种情况下气管插管与存活之间的关联知之甚少。
近期,一项发表在JAMA杂志上的文章进行了一项研究,以确定在成人院内心脏骤停的气管插管是否与存活至出院相关。


此项研究对从2000年1月至2014年12月期间住院心脏骤停的成年患者进行观察性队列研究,包括在获得指南-复苏注册表(一个美国的医院心脏骤停的多中心登记)。排除标准为在心脏骤停时已经有侵入性气道的患者。研究暴露因素为心脏骤停期间急性气管插管。

主要结果是患者出院时的生存。次要结局包括自主循环(ROSC)的恢复和良好的功能结果。脑部性能类别评分为1分(轻度或无神经性缺陷)或2分(中度脑性残疾)则被认为是良好的功能结果。

此项研究结果显示,倾向匹配队列选自668家医院中的10808名成人患者。中位年龄为69岁(四分位数范围,58-79岁),45073例(42%)为女性,24256例(22.4%)存活到出院。

在前15分钟内插管的71615例患者(66.3%)中,43314例(60.5%)与未在同一分钟内插管的患者匹配。与未插管的患者相比,插管患者的生存率较低:43314例中的7052(16.3%)vs.43314例中的8407(19.4%)(风险比[RR]=0.84;95%CI,0.81-0.87;P<0.001)。

插管患者中ROSC的比例低于未插管的患者:43311例中的25022(57.8%)vs.43310例中的25685(59.3%)(RR=0.97;95%CI,0.96-0.99;P<0.001)。

在插管患者中,良好的功能结果也低于未插管的患者:41868例中的4439(10.6%)vs.41733例中的5672(13.6%)(RR=0.78;95%CI,0.75-0.81;P<0.001)。虽然在预先指定的亚组分析中存在差异,但插管与任何亚组的改善结果无关。

此项研究结果表明:院内心脏骤停的成年患者中,在复苏的前15分钟期间的任何给定时间内开始气管插管,与在该时间期间内没有插管相比,与患者出院的生存率降低相关。虽然研究设计没有消除通过适应症混杂的潜力,这些发现不支持成年患者院内心脏骤停的早期气管插管。

原始出处:
Andersen LW, Granfeldt A, Callaway CW, et al. Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival. JAMA. 2017 Jan 24. doi: 10.1001/jama.2016.20165.

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createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-02-04 1e175fdam88(暂无匿称)

    必定有某种原因在里面!

    0

  3. 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createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-02-02 天涯183

    最新研究进展

    0

  4. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173382, encodeId=05cd1e3382b4, content=长见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOWcPEsEP4FrvDcicue5V6rMkmXmY73KjYP59vQrEdjU89iaN4ZkOhsItlHkmGTjhV3b5S3zOQA4E0/0, createdBy=cc261682151, createdName=卡圣, createdTime=Tue Jan 31 06:27:54 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1472346, encodeId=75d714e234673, content=<a href='/topic/show?id=4ea863841a9' target=_blank style='color:#2F92EE;'>#气管插管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63841, encryptionId=4ea863841a9, topicName=气管插管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb5b7213173, createdName=yangfl08, createdTime=Tue Jan 31 02:22:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173290, encodeId=ad5c1e329085, content=不支持成年患者院内心脏骤停的早期气管插管!需要理论依据支持, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160916/IMG57DBEDBBA66BD2947.jpg, createdBy=3b181951777, createdName=ren1mw, createdTime=Mon Jan 30 11:44:34 CST 2017, time=2017-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173264, encodeId=0d361e326432, content=突然想到一个问题,meta分析总结的是平均情况而治疗应该是个体化,那meta还有多少临床指导意义呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-02-02 ylzr123

    院内心脏骤停的成年患者中,在复苏的前15分钟期间的任何给定时间内开始气管插管,与在该时间期间内没有插管相比,与患者出院的生存率降低相关

    0

  5. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173382, encodeId=05cd1e3382b4, content=长见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOWcPEsEP4FrvDcicue5V6rMkmXmY73KjYP59vQrEdjU89iaN4ZkOhsItlHkmGTjhV3b5S3zOQA4E0/0, createdBy=cc261682151, createdName=卡圣, createdTime=Tue Jan 31 06:27:54 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1472346, encodeId=75d714e234673, content=<a href='/topic/show?id=4ea863841a9' target=_blank style='color:#2F92EE;'>#气管插管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63841, encryptionId=4ea863841a9, topicName=气管插管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb5b7213173, createdName=yangfl08, createdTime=Tue Jan 31 02:22:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173290, encodeId=ad5c1e329085, content=不支持成年患者院内心脏骤停的早期气管插管!需要理论依据支持, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160916/IMG57DBEDBBA66BD2947.jpg, createdBy=3b181951777, createdName=ren1mw, createdTime=Mon Jan 30 11:44:34 CST 2017, time=2017-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173264, encodeId=0d361e326432, content=突然想到一个问题,meta分析总结的是平均情况而治疗应该是个体化,那meta还有多少临床指导意义呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-01-31 往日如昨

    继续学习中

    0

  6. 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createdName=yangfl08, createdTime=Tue Jan 31 02:22:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173290, encodeId=ad5c1e329085, content=不支持成年患者院内心脏骤停的早期气管插管!需要理论依据支持, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160916/IMG57DBEDBBA66BD2947.jpg, createdBy=3b181951777, createdName=ren1mw, createdTime=Mon Jan 30 11:44:34 CST 2017, time=2017-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173264, encodeId=0d361e326432, content=突然想到一个问题,meta分析总结的是平均情况而治疗应该是个体化,那meta还有多少临床指导意义呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-01-31 往日如昨

    院内心脏骤停的成年患者中,在复苏的前15分钟期间的任何给定时间内开始气管插管,与在该时间期间内没有插管相比,与患者出院的生存率降低相关

    0

  7. 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createdName=yangfl08, createdTime=Tue Jan 31 02:22:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173290, encodeId=ad5c1e329085, content=不支持成年患者院内心脏骤停的早期气管插管!需要理论依据支持, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160916/IMG57DBEDBBA66BD2947.jpg, createdBy=3b181951777, createdName=ren1mw, createdTime=Mon Jan 30 11:44:34 CST 2017, time=2017-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173264, encodeId=0d361e326432, content=突然想到一个问题,meta分析总结的是平均情况而治疗应该是个体化,那meta还有多少临床指导意义呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-01-31 卡圣

    长见识了

    0

  8. 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createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
  9. 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createdName=yangfl08, createdTime=Tue Jan 31 02:22:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173290, encodeId=ad5c1e329085, content=不支持成年患者院内心脏骤停的早期气管插管!需要理论依据支持, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160916/IMG57DBEDBBA66BD2947.jpg, createdBy=3b181951777, createdName=ren1mw, createdTime=Mon Jan 30 11:44:34 CST 2017, time=2017-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173264, encodeId=0d361e326432, content=突然想到一个问题,meta分析总结的是平均情况而治疗应该是个体化,那meta还有多少临床指导意义呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-01-30 ren1mw

    不支持成年患者院内心脏骤停的早期气管插管!需要理论依据支持

    0

  10. 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createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Feb 02 08:05:08 CST 2017, time=2017-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173392, encodeId=5b711e3392f6, content=继续学习中, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Tue Jan 31 07:08:57 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173391, encodeId=0b251e3391ab, content=院内心脏骤停的成年患者中,在复苏的前15分钟期间的任何给定时间内开始气管插管,与在该时间期间内没有插管相比,与患者出院的生存率降低相关, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Tue Jan 31 07:08:50 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173382, encodeId=05cd1e3382b4, content=长见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOWcPEsEP4FrvDcicue5V6rMkmXmY73KjYP59vQrEdjU89iaN4ZkOhsItlHkmGTjhV3b5S3zOQA4E0/0, createdBy=cc261682151, createdName=卡圣, createdTime=Tue Jan 31 06:27:54 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1472346, encodeId=75d714e234673, content=<a href='/topic/show?id=4ea863841a9' target=_blank style='color:#2F92EE;'>#气管插管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63841, encryptionId=4ea863841a9, topicName=气管插管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb5b7213173, createdName=yangfl08, createdTime=Tue Jan 31 02:22:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173290, encodeId=ad5c1e329085, content=不支持成年患者院内心脏骤停的早期气管插管!需要理论依据支持, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160916/IMG57DBEDBBA66BD2947.jpg, createdBy=3b181951777, createdName=ren1mw, createdTime=Mon Jan 30 11:44:34 CST 2017, time=2017-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=173264, encodeId=0d361e326432, content=突然想到一个问题,meta分析总结的是平均情况而治疗应该是个体化,那meta还有多少临床指导意义呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Mon Jan 30 09:12:48 CST 2017, time=2017-01-30, status=1, ipAttribution=)]
    2017-01-30 wmu姿

    突然想到一个问题,meta分析总结的是平均情况而治疗应该是个体化,那meta还有多少临床指导意义呢

    0

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