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Crit Care Med:心脏骤停复苏后平均动脉血压升高与神经系统结局之间的关系

2018-10-11 xing.T MedSci原创

由此可见,心脏骤停复苏后最初6小时内血压升高与出院时良好的神经功能独立相关。需要进一步调查以确定针对平均动脉血压升高是否会改善心脏骤停后的神经系统结局。

实验室研究表明心脏骤停复苏后血压升高可能具有保护作用;但是,临床数据有限。近日,危重病医学领域权威杂志Critical Care Medicine上发表了一篇研究文章,研究人员旨在评估这一假设,即复苏后平均动脉血压与神经系统结局有关。

该研究是在美国六所教学医院进行的前瞻性队列研究,参与者为非创伤性心脏骤停成年患者,这些患者在自发循环恢复后接受靶向温度治疗。研究人员在受试者自发循环恢复后无创地测量了平均动脉血压,并在自发循环恢复后的最初6小时内每小时测量一次血压。

研究人员计算了平均动脉血压,并将受试者分为两组:平均动脉血压70-90mmHg组和大于90mmHg组。主要结局是良好的神经功能,定义为改良Rankin量表评分小于或等于3。在出院时前瞻性确定了改良Rankin量表评分。在所包含的269名患者中,159名(59%)患者的平均动脉血压大于90mmHg。整个队列中30%的患者出院时具有良好的神经功能,平均动脉血压大于90mmHg(42%)的患者与平均动脉血压70-90 mmHg的患者相比比例更高(15%)(绝对风险差异为27%; 95%CI为17-37%)。在调整潜在混杂因素的多变量泊松回归模型中,平均动脉血压大于90mmHg与良好的神经功能相关(调整后的相对风险为2.46; 95%CI为2.09-2.88)。在平均动脉血压上升的范围内,良好神经系统结局的概率呈剂量反应性增加,在平均动脉血压大于110mmHg的患者中具有最强的相关性(调整后的相对风险为2.97; 95%CI为1.86-4.76)。

由此可见,心脏骤停复苏后最初6小时内血压升高与出院时良好的神经功能独立相关。需要进一步调查以确定针对平均动脉血压升高是否会改善心脏骤停后的神经系统结局。

原始出处:

Roberts, Brian W.et al. Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study.critical care medicine.2018. https://journals.lww.com/ccmjournal/Abstract/onlinefirst/Association_Between_Elevated_Mean_Arterial_Blood.96117.aspx

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    2018-10-13 lizhou0204
  5. [GetPortalCommentsPageByObjectIdResponse(id=1708993, encodeId=45b71e0899329, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=048f31575940, createdName=ms9833124466084992, createdTime=Tue Mar 26 19:51:00 CST 2019, time=2019-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718944, encodeId=6d591e18944e5, content=<a href='/topic/show?id=32b888935ca' target=_blank style='color:#2F92EE;'>#血压升高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88935, encryptionId=32b888935ca, topicName=血压升高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c86e32676392, createdName=zhang92571, createdTime=Mon Sep 02 02:51:00 CST 2019, time=2019-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283094, encodeId=9491128309409, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sat Oct 13 07:51:00 CST 2018, time=2018-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305453, encodeId=58c81305453f0, content=<a href='/topic/show?id=270342e249d' target=_blank style='color:#2F92EE;'>#复苏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42724, encryptionId=270342e249d, topicName=复苏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Sat Oct 13 07:51:00 CST 2018, time=2018-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1609176, encodeId=95d716091e6b0, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sat Oct 13 07:51:00 CST 2018, time=2018-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=349064, encodeId=9dec349064d3, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Fri Oct 12 21:34:42 CST 2018, time=2018-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348911, encodeId=06d134891152, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Thu Oct 11 17:11:54 CST 2018, time=2018-10-11, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1708993, encodeId=45b71e0899329, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=048f31575940, createdName=ms9833124466084992, createdTime=Tue Mar 26 19:51:00 CST 2019, time=2019-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718944, encodeId=6d591e18944e5, content=<a href='/topic/show?id=32b888935ca' target=_blank style='color:#2F92EE;'>#血压升高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88935, encryptionId=32b888935ca, topicName=血压升高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c86e32676392, createdName=zhang92571, createdTime=Mon Sep 02 02:51:00 CST 2019, time=2019-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283094, encodeId=9491128309409, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sat Oct 13 07:51:00 CST 2018, time=2018-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305453, encodeId=58c81305453f0, content=<a href='/topic/show?id=270342e249d' target=_blank style='color:#2F92EE;'>#复苏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42724, encryptionId=270342e249d, topicName=复苏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Sat Oct 13 07:51:00 CST 2018, time=2018-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1609176, encodeId=95d716091e6b0, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sat Oct 13 07:51:00 CST 2018, time=2018-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=349064, encodeId=9dec349064d3, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Fri Oct 12 21:34:42 CST 2018, time=2018-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348911, encodeId=06d134891152, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Thu Oct 11 17:11:54 CST 2018, time=2018-10-11, status=1, ipAttribution=)]
    2018-10-12 医者仁心5538

    学习了

    0

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    2018-10-11 一天没事干

    很好的学习机会

    0

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