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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2018, Vol. 11 ›› Issue (05) : 304 -309. doi: 10.3877/cma.j.issn.1674-6880.2018.05.005

所属专题： 文献；

论著

温州地区开展亚低温治疗对心肺复苏后昏迷患者预后影响的研究
雷远丽1, 卢颖如1,†(), 陈寿权1, 李章平1, 李惠萍1, 许华清1, 孙来芳2, 尤荣开3, 陈新国4, 阮战伟5, 刘晓6, 金细众7, 陈朴8, 徐良志9, 黄增峰10, 吴小明11   
  1. 1. 325000　浙江温州，温州医科大学附属第一医院急诊科
    2. 325027　浙江温州，温州医科大学附属第二医院急诊科
    3. 325000　浙江温州，温州市中心医院重症医学科
    4. 325041　浙江温州，温州市人民医院急诊科
    5. 325200　浙江温州，瑞安市人民医院急诊科
    6. 325000　浙江温州，温州市中医院急诊科
    7. 325000　浙江温州，温州中西医结合医院重症医学科
    8. 325600　浙江乐清，乐清市人民医院重症医学科
    9. 325400　浙江温州，平阳县人民医院重症医学科
    10. 325800　浙江温州，苍南县中医院急诊科
    11. 325300　浙江温州，文成县人民医院急诊科
  • 收稿日期:2018-04-13 出版日期:2018-10-01
  • 通信作者: 卢颖如
  • 基金资助:
    浙江省科技厅项目(2013T301-13)

Prognosis of hypothermia treatment for coma patients after cardiopulmonary resuscitation in Wenzhou

Yuanli Lei1, Yingru Lu1,†(), Shouquan Chen1, Zhangping Li1, Huiping Li1, Huaqing Xu1, Laifang Sun2, Rongkai You3, Xinguo Chen4, Zhanwei Ruan5, Xiao Liu6, Xizhong Jin7, Pu Chen8, Liangzhi Xu9, Zengfeng Huang10, Xiaoming Wu11   

  1. 1. Department of Emergency, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
    2. Department of Emergency, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
    3. Department of Critical Care Medicine, Wenzhou Central Hospital, Wenzhou 325000, China
    4. Department of Emergency, Wenzhou People's Hospital, Wenzhou 325041, China
    5. Department of Emergency, Ruian People's Hospital, Wenzhou 325200, China
    6. Department of Emergency, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
    7. Department of Critical Care Medicine, Wenzhou Hospital of Integrated Chinese and Western Medicine, Wenzhou 325000, China
    8. Department of Critical Care Medicine, Yueqing People's Hospital, Yueqing 325600, China
    9. Department of Critical Care Medicine, People's Hospital of Pingyang, Wenzhou 325400, China
    10. Department of Emergency, Cangnan Hospital of Traditional Chinese Medicine, Wenzhou325800, China
    11. Department of Emergency, Wencheng People's Hospital, Wenzhou 325300, China
  • Received:2018-04-13 Published:2018-10-01
  • Corresponding author: Yingru Lu
  • About author:
    Corresponding author: Lu Yingru, Email:
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引用本文：

雷远丽, 卢颖如, 陈寿权, 李章平, 李惠萍, 许华清, 孙来芳, 尤荣开, 陈新国, 阮战伟, 刘晓, 金细众, 陈朴, 徐良志, 黄增峰, 吴小明. 温州地区开展亚低温治疗对心肺复苏后昏迷患者预后影响的研究[J/OL]. 中华危重症医学杂志(电子版), 2018, 11(05): 304-309.

Yuanli Lei, Yingru Lu, Shouquan Chen, Zhangping Li, Huiping Li, Huaqing Xu, Laifang Sun, Rongkai You, Xinguo Chen, Zhanwei Ruan, Xiao Liu, Xizhong Jin, Pu Chen, Liangzhi Xu, Zengfeng Huang, Xiaoming Wu. Prognosis of hypothermia treatment for coma patients after cardiopulmonary resuscitation in Wenzhou[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(05): 304-309.

目的

探讨温州地区推广亚低温治疗（HT）对心肺复苏（CPR）后昏迷患者预后的影响。

方法

温州地区成立1家推广示范基地及10家推广基地，自2014年1月至2016年12月，对CPR后昏迷患者实施HT。记录所有患者亚低温治疗相关信息，比较推广期间3年患者ICU出院存活率、神经功能恢复良好率及严重致残率。

结果

推广期间共对133例CPR后昏迷患者实施HT，推广第1年、第2年、第3年分别为28、46、59例。推广第1年、第2年、第3年达到目标体温时间[8.0（3.0，18.8）、10.0（4.8，20.0）、6.0（2.0，12.0）h]、药物使用率[17（60.7%）、43（93.5%）、42（71.2%）]及肌松剂使用率[0（0%）、1（2.2%）、13（22.0%）]比较，差异均有统计学意义（H = 10.475，P = 0.005；χ2 = 12.250，P = 0.002；χ2 = 17.647，P < 0.001）。推广期间ICU出院存活率呈现逐年上升趋势，严重致残率呈现逐年下降趋势；但3年间比较差异均无统计学意义（χ2 = 2.537，P = 0.281；χ2 = 0.308，P = 0.857）。推广3年间神经功能恢复良好率比较，差异有统计学意义（χ2 = 12.232，P =0.002），且推广第3年较第1年及第2年神经功能恢复良好率更高[16（27.1%）、1（3.6%）、3（6.5%），P均< 0.017]。

结论

规范化的HT能有效地促进神经功能恢复。

关键词: 心肺复苏术, 昏迷, 亚低温, 目标体温管理, 心脏骤停
Objective

To analyze the prognosis of hypothermia treatment (HT) for coma patients after cardiopulmonary resuscitation (CPR) in Wenzhou.

Methods

A implementation demonstration base and 10 implementation bases were established in Wenzhou. HT was implemented in patients with coma after CPR from January 2014 to December 2016. The data of HT were recorded. The survival rate of ICU discharge, recovery rate of neurological functions and severe disability rate in the 3-year implementation period were compared.

Results

In the implementation period, 133 coma patients after CPR were implemented TH. Respectively, 28, 46 and 59 cases were implemented in the first, second and third years. Time to target temperature [8.0 (3.0, 18.8), 10.0 (4.8, 20.0), 6.0 (2.0, 12.0) h], and rates of drug use [17 (60.7%), 43 (93.5%), 42 (71.2%)] and muscle relaxant use [0 (0%), 1 (2.2%), 13 (22.0%)] were significantly different in the first, second and third years (H = 10.475, P = 0.005; χ2 = 12.250, P = 0.002; χ2 = 17.647, P < 0.001). The survival rate of ICU discharge presented an upward trend, and the severe disability rate showed an downward trend year by year. However, there were no significant differences in above indicators (χ2 = 2.537, P = 0.281; χ2 = 0.308, P = 0.857) during the implementation period. The recovery rate of neurological functions during the implementation period was significantly different (χ2 = 12.232, P = 0.002); it was higher in the third year than in the first and second years [16 (27.1%), 1 (3.6%), 3 (6.5%), both P < 0.017).

Conclusion

The standardized HT can significantly improve favorable neurological recovery.

Key words: Cardiopulmonary resuscitation, Coma, Hypothermia treatment, Targeted temperature management, Cardiac arrest
表1 推广期间心肺复苏患者一般资料
组别 例数 男/女 年龄（岁，±s） 心源性[例(%)] 创伤性[例(%)] 电击伤[例(%)] 院外CA[例(%)] CA时初始节律为可除颤心律[例(%)] CPR开始时间≦5 min[例(%)] CPR持续时间≦15 min[例(%)] ICU住院天数[d, M（P25，P75)]
第1年 28 21/7 49.0 ± 19.1 4(14.3) 3(10.7) 4(14.3) 21(75.0) 9(32.1) 11(39.3) 11(39.3) 6.0(1.3,18.0)
第2年 46 30/16 56.4 ± 18.6 13(28.3) 2(4.3) 2(4.3) 31(67.4) 9(19.6) 13(28.3) 26(56.5) 7.5(2.8,16.3)
第3年 59 43/16 55.7 ± 18.5 15(25.4) 4(6.8) 6(10.2) 38(64.4) 12(20.3) 28(47.5) 26(44.1) 6.0(3.0,16.0)
χ2/F/H值 ? 1.052 1.556 1.968 1.079 2.396 0.976 1.875 4.001 2.537 0.319
P值 ? 0.591 0.215 0.374 0.583 0.302 0.614 0.392 0.135 0.281 0.852
表2 推广期间实施亚低温患者亚低温相关信息
组别 例数 开始亚低温时间[h,M(P25,P75)] 达到目标体温时间[h,M(P25,P75)] 维持目标体温时间12 ~ 48 h [例(%)] 药物使用率[例(%)] 肌松剂使用率[例(%)]
第1年 28 4(2.3,10.0) 8.0(3.0,18.8) 18(64.3) 17(60.7) 0(0)
第2年 46 5(2.9,10.0) 10.0(4.8,20.0) 31(67.4) 43(93.5)b 1(2.2)
第3年 59 5(3.0,8.0) 6.0(2.0,12.0)a 41(69.5) 42(71.2)c 13(22.0)c
χ2/F/H值 ? 0.276 10.475 0.238 12.250 17.647
P值 ? 0.871 0.005 0.888 0.002 < 0.001
表3 推广期间实施亚低温患者疗效分析[例（%）]
组别 例数 ICU出院存活率 神经功能恢复良好率 严重致残率
第1年 28 12(42.9) 1(3.6) 8(66.7)
第2年 46 25(54.3) 3(6.5) 16(64.0)
第3年 59 36(61.0) 16(27.1)ab 19(52.8)
χ2值 ? 2.537 12.232 0.308
P值 ? 0.281 0.002 0.857
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