CAJ | 학술논문

目的观察心肺复苏时持续静脉泵注硝酸甘油对院外心跳骤停患者恢复自主循环(ROSC)及生存出院率的影响,探讨硝酸甘油改善患者预后的可能机制.方法以南京同仁医院急诊科接诊的院外心跳呼吸骤停患者为研究对象,预设样本量120例,按序号随机分为干预组和对照组,性别不限.干预组给予标准心肺复苏,并给予静脉持续泵入硝酸甘油；对照组进行标准心肺复苏,不应用硝酸甘油.排除心跳骤停后过长时间未进行基础生命支持者、慢性疾病终末期、癌症晚期、家属放弃抢救者,入选患者共93例,干预组44例,对照组49例.观察两组患者ROSC例数、ROSC时间及出院生存例数.结果干预组有17例恢复自主循环,有效率为38.64％；对照组有9例恢复自主循环,有效率为18.37％,干预组有效率显著高于对照组,差异有统计学意义(x2=4.729,P＜0.05).干预组和对照组自基础生命支持(BLS)开始至ROSC的时间分别为(23±22)min和(16±9) min,差异无统计学意义(P＞0.05).干预组生存出院5例,生存率为11.4％；对照组生存出院2例,生存率为4.1％.结论心肺复苏过程中应用硝酸甘油持续静脉泵入可显著提高患者ROSC率,并可能提高生存出院率.硝酸甘油可能通过舒张小动脉,改善器官微循环灌流,并通过降低肺循环阻力,改善通气/血流比值,增加心输出量,从而改善复苏时重要器官的功能及预后.
목적 관찰심폐복소시지속정맥빙주초산감유대원외심도취정환자회복자주순배(ROSC)급생존출원솔적영향,탐토초산감유개선환자예후적가능궤제.방법 이남경동인의원급진과접진적원외심도호흡취정환자위연구대상,예설양본량120례,안서호수궤분위간예조화대조조,성별불한.간예조급여표준심폐복소,병급여정맥지속빙입초산감유；대조조진행표준심폐복소,불응용초산감유.배제심도취정후과장시간미진행기출생명지지자、만성질병종말기、암증만기、가속방기창구자,입선환자공93례,간예조44례,대조조49례.관찰량조환자ROSC례수、ROSC시간급출원생존례수.결과 간예조유17례회복자주순배,유효솔위38.64％；대조조유9례회복자주순배,유효솔위18.37％,간예조유효솔현저고우대조조,차이유통계학의의(x2=4.729,P＜0.05).간예조화대조조자기출생명지지(BLS)개시지ROSC적시간분별위(23±22)min화(16±9) min,차이무통계학의의(P＞0.05).간예조생존출원5례,생존솔위11.4％；대조조생존출원2례,생존솔위4.1％.결론 심폐복소과정중응용초산감유지속정맥빙입가현저제고환자ROSC솔,병가능제고생존출원솔.초산감유가능통과서장소동맥,개선기관미순배관류,병통과강저폐순배조력,개선통기/혈류비치,증가심수출량,종이개선복소시중요기관적공능급예후.
Objective To observe the effect of continuous pump-infusion of nitroglycerin in cardiopulmonary resuscitation during advanced life support on the pre-hospital cardiac arrest patients and explore the possible mechanisms of nitroglycerin in improving the outcome.Methods Pre-hospital patients were taken as the object of the study with cardiac arrest treated in the department of emergency.The sample size of 120 cases were designed and stochastically separated into control group and intervening group in cardiopulmonary resuscitation during advanced life support according to the serial number in advance,with gender being ignored.The intervening group was given standard cardiopulmonary resuscitation and the assistant therapy of continuous pump-infusion of nitroglycerin,while the control group was just given standard cardiopulmonary resuscitation.Cases were excluded including those who were too long after cardiac arrest without BLS,who were in end-stage of cancer or any other chronic diseases,and those who were given up rescue by their relatives.Forty-four cases of the remaining 93 cases were in the intervention group and 49 cases in the control group.The number of restoration of spontaneous circulation (ROSC),the time from the beginning of BLS to the point of ROSC and the number of survival to hospital discharge were observed.Results There were 17 cases in the intervention group and 9 cases in the control group restored spontaneous circulation.The time from the beginning of BLS to ROSC between the two groups had no significant difference [(23 ±22) min vs(16 ±9) min,P ＞ 0.05].The efficiency rate of the intervention group was significantly higher than that of the control group(38.6％ vs 18.4％,x2 =4.329,P ＜ 0.05).There were 5 cases survived to hospital discharge in the intervention group,while 2 cases in the control group,with the survival rate of respectively 11.4％ and 4.1％.Conclusions Continuous pump-infusion of nitroglycerin might significantly increase the rate of ROSC in cardiopulmonary resuscitation and improve survival to hospital discharge rate.Nitroglycerin might improve the vital organs' function during CPR and lead to better outcome by increasing the perfusion of the microcirculation of vital organs,decreasing the pulmonary vascular resistance,improving ventilation perfusion ratio and cardiac output.