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BMJ:院内心脏骤停患者接受早期肾上腺素治疗到底是好还是坏?

2016-04-07 MedSci MedSci原创

该研究的目的是评估在医院内经历心脏骤停的患者第一次除颤后两分钟内是否接受了肾上腺素的治疗(与美国心脏协会指南相反),并评估在这一人群中,早期给予肾上腺素治疗和患者结果之间的关联。

该研究的目的是评估在医院内经历心脏骤停的患者第一次除颤后两分钟内是否接受了肾上腺素的治疗(与美国心脏协会指南相违背),并评估在这一人群中,早期给予肾上腺素治疗和患者结果之间的关联。

该前瞻性观察队列研究的数据来自于美国300多家医院的数据。该研究的参与者包括在医院经历过心脏骤停并有可电击心律的成人患者,这些患者在心脏骤停两分钟内接受了第一次除颤,并且在除颤后仍处于可电击心律。干预措施为第一次除颤后给予肾上腺素。

主要结果指标为患者幸存至出院。次要终点包括自主循环恢复并且幸存至出院,具有良好的功能结果。倾向评分用来计算第一次除颤后两分钟内接受肾上腺素的情况,基于患者,事件和医院的多个特征进行计算。在第一次除颤后的0,1,2分钟接受肾上腺素的患者通过倾向得分匹配了那些应在同一时间接受肾上腺素的“处于危险”的患者,但这些患者却没有接受肾上腺素治疗。

共有2978例患者进行了倾向评分匹配,并进行了很好的平衡。1510(51%)例患者在第一次除颤后的两分钟内接受肾上腺素,这与当前美国心脏协会指南是相违背的。在倾向得分匹配分析中,第一次除颤之后的第一个两分钟内给予肾上腺素降低了生存率(比值比0.70,95%置信区间0.59至0.82; P<0.001)。早期的肾上腺素管理也降低了自主循环恢复的几率(0.71,0.60〜0.83; P <0.001)和良好的功能结局(0.69,0.58至0.83; P<0.001)。

有一半的患者有持续电击心律时,在第一次除颤后两分钟内接受肾上腺素,这与当前的美国心脏协会指南是相违背的。第一次除颤后两分钟内接受肾上腺素降低了存活至出院的几率,也降低了自主循环恢复的几率以及具有良好功能结局至出院的可能性。

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    2016-05-22 gaoxiaoe
  5. [GetPortalCommentsPageByObjectIdResponse(id=2080400, encodeId=50742080400c1, content=<a href='/topic/show?id=95d198298d8' target=_blank style='color:#2F92EE;'>#院内心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98298, encryptionId=95d198298d8, topicName=院内心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f612331, createdName=gds2009, createdTime=Fri Jul 22 13:23:00 CST 2016, time=2016-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1808844, encodeId=36af18088448c, content=<a href='/topic/show?id=14bf82442fb' target=_blank style='color:#2F92EE;'>#肾上腺素治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82442, encryptionId=14bf82442fb, topicName=肾上腺素治)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570f404, createdName=xlxchina, createdTime=Fri May 20 10:23:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895062, encodeId=c33a1895062f3, content=<a href='/topic/show?id=ce478241e0b' target=_blank style='color:#2F92EE;'>#肾上腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82417, encryptionId=ce478241e0b, topicName=肾上腺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dba135, createdName=xuyong523, createdTime=Tue May 17 06:23:00 CST 2016, time=2016-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1847952, encodeId=6ef9184e952b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun May 22 18:23:00 CST 2016, time=2016-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78264, encodeId=d627e8264e3, content=m文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78265, encodeId=a894e826546, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284875, encodeId=d9f412848e51b, content=<a href='/topic/show?id=b67d8244123' target=_blank style='color:#2F92EE;'>#肾上腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82441, encryptionId=b67d8244123, topicName=肾上腺素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Sat Apr 09 07:23:00 CST 2016, time=2016-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=76444, encodeId=7e2ce644402, content=研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=224, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Apr 08 19:48:00 CST 2016, time=2016-04-08, status=1, ipAttribution=)]
    2016-04-14 李继凯

    m文章不错

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2080400, encodeId=50742080400c1, content=<a href='/topic/show?id=95d198298d8' target=_blank style='color:#2F92EE;'>#院内心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98298, encryptionId=95d198298d8, topicName=院内心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f612331, createdName=gds2009, createdTime=Fri Jul 22 13:23:00 CST 2016, time=2016-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1808844, encodeId=36af18088448c, content=<a href='/topic/show?id=14bf82442fb' target=_blank style='color:#2F92EE;'>#肾上腺素治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82442, encryptionId=14bf82442fb, topicName=肾上腺素治)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570f404, createdName=xlxchina, createdTime=Fri May 20 10:23:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895062, encodeId=c33a1895062f3, content=<a href='/topic/show?id=ce478241e0b' target=_blank style='color:#2F92EE;'>#肾上腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82417, encryptionId=ce478241e0b, topicName=肾上腺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dba135, createdName=xuyong523, createdTime=Tue May 17 06:23:00 CST 2016, time=2016-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1847952, encodeId=6ef9184e952b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun May 22 18:23:00 CST 2016, time=2016-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78264, encodeId=d627e8264e3, content=m文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78265, encodeId=a894e826546, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284875, encodeId=d9f412848e51b, content=<a href='/topic/show?id=b67d8244123' target=_blank style='color:#2F92EE;'>#肾上腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82441, encryptionId=b67d8244123, topicName=肾上腺素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Sat Apr 09 07:23:00 CST 2016, time=2016-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=76444, encodeId=7e2ce644402, content=研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=224, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Apr 08 19:48:00 CST 2016, time=2016-04-08, status=1, ipAttribution=)]
    2016-04-14 李继凯

    值得关注

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2080400, encodeId=50742080400c1, content=<a href='/topic/show?id=95d198298d8' target=_blank style='color:#2F92EE;'>#院内心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98298, encryptionId=95d198298d8, topicName=院内心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f612331, createdName=gds2009, createdTime=Fri Jul 22 13:23:00 CST 2016, time=2016-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1808844, encodeId=36af18088448c, content=<a href='/topic/show?id=14bf82442fb' target=_blank style='color:#2F92EE;'>#肾上腺素治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82442, encryptionId=14bf82442fb, topicName=肾上腺素治)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570f404, createdName=xlxchina, createdTime=Fri May 20 10:23:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895062, encodeId=c33a1895062f3, content=<a href='/topic/show?id=ce478241e0b' target=_blank style='color:#2F92EE;'>#肾上腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82417, encryptionId=ce478241e0b, topicName=肾上腺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dba135, createdName=xuyong523, createdTime=Tue May 17 06:23:00 CST 2016, time=2016-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1847952, encodeId=6ef9184e952b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun May 22 18:23:00 CST 2016, time=2016-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78264, encodeId=d627e8264e3, content=m文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78265, encodeId=a894e826546, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284875, encodeId=d9f412848e51b, content=<a href='/topic/show?id=b67d8244123' target=_blank style='color:#2F92EE;'>#肾上腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82441, encryptionId=b67d8244123, topicName=肾上腺素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Sat Apr 09 07:23:00 CST 2016, time=2016-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=76444, encodeId=7e2ce644402, content=研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=224, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Apr 08 19:48:00 CST 2016, time=2016-04-08, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=2080400, encodeId=50742080400c1, content=<a href='/topic/show?id=95d198298d8' target=_blank style='color:#2F92EE;'>#院内心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98298, encryptionId=95d198298d8, topicName=院内心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f612331, createdName=gds2009, createdTime=Fri Jul 22 13:23:00 CST 2016, time=2016-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1808844, encodeId=36af18088448c, content=<a href='/topic/show?id=14bf82442fb' target=_blank style='color:#2F92EE;'>#肾上腺素治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82442, encryptionId=14bf82442fb, topicName=肾上腺素治)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570f404, createdName=xlxchina, createdTime=Fri May 20 10:23:00 CST 2016, time=2016-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895062, encodeId=c33a1895062f3, content=<a href='/topic/show?id=ce478241e0b' target=_blank style='color:#2F92EE;'>#肾上腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82417, encryptionId=ce478241e0b, topicName=肾上腺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dba135, createdName=xuyong523, createdTime=Tue May 17 06:23:00 CST 2016, time=2016-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1847952, encodeId=6ef9184e952b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun May 22 18:23:00 CST 2016, time=2016-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78264, encodeId=d627e8264e3, content=m文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=78265, encodeId=a894e826546, content=值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:51:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284875, encodeId=d9f412848e51b, content=<a href='/topic/show?id=b67d8244123' target=_blank style='color:#2F92EE;'>#肾上腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82441, encryptionId=b67d8244123, topicName=肾上腺素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Sat Apr 09 07:23:00 CST 2016, time=2016-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=76444, encodeId=7e2ce644402, content=研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=224, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Apr 08 19:48:00 CST 2016, time=2016-04-08, status=1, ipAttribution=)]
    2016-04-08 1de3b290m83(暂无匿称)

    研究

    0

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