摘要
目的 评价不同心内途径注射首剂肾上腺素对心肺复苏（cardiopulmonary resuscitation,CPR）效果的影响.方法 筛选2007年12月～2013年12月院内心搏骤停接受CPR病例753例,依据CPR时首剂肾上腺素注射途径,分为中心静脉给药组（CV组,315例）、外周静脉给药组（PV组,271例）及心内注射组（ICI组,167例）.进而根据年龄、性别、心搏骤停前左心室舒张末期内径（left ventricular end diastolic dimension,LVEDD）及左心室射血分数（left ventricular ejection fraction,LVEF）4项因素进行匹配,在3组病例中各选择82例共246例进行统计学研究.比较3组自主循环恢复比例、所需时间、电除颤次数及肾上腺素使用剂量,记录心内途径注射并发症.比较3组CPR后l、24 h及出院存活率.结果 PV、CV、ICI 3组自主循环恢复率分别为36.5％、39.0％、43.9％,所需时间分别为（6.8±1.3）、（5.5±1.5）、（4.1±1.1） min,电击次数分别为（5.0±1.5）、（4.0±1.2）、（3.0±1.3）次,肾上腺素使用剂量分别为（7.5±1.8）、（6.3±1.2）、（5.0±1.5） mg.PV组CPR后1、24h及出院存活率分别为34.1％、30.4％、25.6％,CV组CPR后1、24 h及出院存活率分别为36.5％、24.4％、24.3％,ICI组CPR后1、24 h及出院存活率分别为40.2％、39.0％、25.6％.与PV、CV组比较,ICI组自主循环恢复比例最高（P＜0.05）,所需时间最短（P＜0.05）,电除颤次数和肾上腺素使用剂量最少（P＜0.05）,CPR后1、24 h存活率最高（P＜0.05）.CV组CPR后24 h存活率最低（P＜0.05）;余指标优于PV组,差异有统计学意义（P＜0.05）.3组出院存活率比较,差异无统计学意义（P＞0.05）.ICI组1例心包内出血＞50 ml行穿刺引流预后良好.结论 心搏骤停暂无静脉给药途径时,心内注射首剂肾上腺素可有效提高CPR成功率.
Objective To investigate the impact of initial dose epinephrine in different administration routes on the successful rate and the short-term prognosis of cardiopulmonary resuscitation （CPR）.Methods From december 2007 to december 2013,246 patients with cardiac arrest who received CPR were retrospectively analyzed.According to the different administration routes of initial dose epinephrine during CPR,264 patients were randomly divided into 3 groups：peripheral venous （PV） group （group PV）,central venous （CV） group （group CV） and intracardiac injection （ICI） group （group ICI）.The rate and time of spontaneous circulation restoration,the times of electric defibrillation,the dose of epinephrine,and complications of the intracardiac injection were recorded.Then the survival rates of 1,24 h after CPR and out of hospital were recorded.Retrospective analysis was carried out.Results The rate of spontaneous circulation restoration in group PV,CV and ICI were 36.5%,39.0% and 43.9% respectively.The time of spontaneous circulation restoration in group PV,CV and ICI were （6.8±1.3）,（5.5±1.5） min and （4.1±1.1） min,the times of electric defibrillation were （5.0±1.5）,（4.0±1.2） min and （3.0±1.3） min,the dose of epinephrine were （7.5±1.8）,（6.3±1.2） mg and （5.0±1.5） mg in group PV,CV and ICI.The survival rates of 1,24 h after CPR and out of hospital were 34.1%,30.4% and 25.6% in group PV,36.5%,24.4% and 24.3% in group CV,40.2%,9.0% and 25.6% in group ICI.Among the three groups,there was obviously higher rate and shorter time of spontaneous circulation restoration （P〈0.05）,distinctively less times of electric defibrillation and less dose of epinephrine （P〈0.05） in group ICI.And the survival rates of 1 h and 24 h after CPR were apparently higher （P〈0.05） in group ICI.One case occurred pericardial hemorrhage with more than 50 ml lost and pericardiocentesis and drainage was performed timely.The survival rates out of hospital of the three groups were no significant statistical differences.Conclusions An intravenous route of administration was not readily available when cardiac arrest,intracardiac injection of initial dose epinephrine could effectively improve the rate of cardiopulmonary resuscitation.
出处
《国际麻醉学与复苏杂志》
CAS
2015年第4期297-301,共5页
International Journal of Anesthesiology and Resuscitation
关键词
心肺复苏
心内注射
首剂
肾上腺素
Cardiopulmonary resuscitation
Intracardiac injection
Initial dose
Epinephrine
