摘要
目的探讨肾上腺素递增剂量方程G=(K+2^x-1)mg/3min(K=1、2,n=1、2……5,G≤0.2mg/kg)与氨茶碱快速同步联合在心肺复苏(CPR)中的应用效果及临床价值。方法将376例心搏骤停患者随机分成3组。采用肘静脉通道分别静脉推注(静推)给药:①对照组(130例):首次静推肾上腺素1mg,若无效则每隔3min重复首次剂量。②方程中首剂量K=1mg为方程1组(122例);K=2mg为方程2组(124例)。方程1组首次静推肾上腺素1mg和氨茶碱7mg/kg,若无效则每隔3min按方程计算出的肾上腺素递增剂量以2、3……17mg和氨茶碱7mg/kg快速同步静推1次;方程2组首次静推肾上腺素2mg和氨茶碱7mg/kg,若无效则每3min按方程计算出的肾上腺素递增剂量以3、4……18mg和氨茶碱7mg/kg快速同步静推1次。当肾上腺素递增剂量超过0.2mg/kg时则停药。监测各组心电、平均动脉压(MAP)、心率(HR)、自主循环恢复(+ROSC)的时间,并进行复苏效果评价。结果①方程2组和方程1组+ROSC率(91.13%,88.52%)、24h存活率(85.48%,67.21%)、出院存活率(49.19%,31.15%)、存活出院者格拉斯哥昏迷评分[GCS,(13.12±1.27)分,(12.28±1.32)分]均较对照组[26.92%、25.39%、12.31%、(9.08±1.13)分]显著升高(P均〈0.01),CPR开始用药至+ROSC时间[(8.93±3.27)min、(8.25±5.25)min]较对照组[(39.25±9.75)mini显著缩短(P均〈0.01)。②方程2组和方程1组从CPR开始至+ROSC所用肾上腺素量较对照组明显减少[(11.75±3.25)mg,(13.85±5.15)mg比(24.65±4.35)mg,P均〈0.053,两组达到+ROSC所需静推肾上腺素次数也较对照组显著减少[(3.45±0.55)次、(3.85±0.75)次比(18.25±0.75)次,P均〈0.01]。结论采用肾上腺素递增剂量方程和氨茶碱7mg/kg快速同步联合应用,在CPR流程中能显著提高+ROSC率和存活率,显著缩短ROSC时间,明显改善神经功能,提高复苏时的效应。
Objective To investigate the effect of application and clinical value of use of epinephrine in graduate increased dosage according to the equation G : (K + 2^x-1 )mg/3 minutes (K = 1, 2, n = 1, 2 5, G≤0.2 mg/kg ) combined with aminophyline in cardiopulmonary resuscitation (CPR). Methods Three hundred and seventy-six patients with sudden cardiacarrest (CA) were randomly divided into 3 groups. Epinephrine and aminophyline were given through cubital vein with following methods: (1) Control: (n=130). 1 mg of adrenaline was given as the first treatment. Repeat the same every 3 minutes if there was no effect. (2) In one hundred and thirty cases, the first dose of epinephrine was K = 1 mg (n = 122), K=2 mg (n= 124). In K= 1 mg group,epinephrine 1 mg and aminophyline 7 mg/kg were given as the first dose. If it was not effective, increasing dosage of epinephrine in order of 2, 3 17 mg and aminophrine 7 mg/kg was given intravenously successively every 3 minutes (K= 1, 2, n= 1, 2 5). In group 2 (group equation 2), eqinephrine 2 mg and aminophyline 7 mg/kg were given rapidly intravenously. If not effective, the drugs were repeated according to the equation intravenously every 3 minutes. When the dose of epimephrine exceeded 0. 2 mg/kg, it should be stopped. Electrocadiogram, mean arterial pressure (MAP), the heart rate (HR), and the time of recovery of spontaneous circulation (+ROSC) were monitored, and they were evaluated for the effectiveness of resuscitation. Results (1)+ROSC rate (91.13%, 88.52%), the 24-hour survival rate (85.48%, 67.21%), the survival rate (49.19%, 31.15%), and the Glasgow coma scores [(13.12±1.27)scores, (12.28± 1.32) scores] were all significantly elevated in groups in which patients received the modified regime compared with the control group [26.92%, 25.39%, 12.31% and (9.08±1.13) scores, all P〈0.01]. The average time for +ROSC in the equation 2 and 1 groups was (8.93±3.27) minutes and (8.25 ± 5.25) minutes, respectively, and they were significantly shorter than those of the control group [(39.25±9.75) minutes, both P〈0.01]. (1) The average dose of the epinephrine was much reduced in achieving +ROSC in two groups with modified regimes as compared with control group [(11.75±3.25) mg and (13.85±5.15)mg, respectively vs. (24.65±4.35) rag, both P〈0. 05], and the number of using application epinephrine via intravenous from the CPR initial stage to +ROSC in the equation 2 and 1 groups was much significantly decreased compared with the control group [(3.45 ± 0.55) times and (3.85±0.75) times vs. (18.25±0.75) times, both P〈0. 013. Conclusion The newly formed regime has better effects in increasing significantly the success rate of cardiac-resucitation, the survival rate, and it also shortens the time for successful recovery of spontaneous circulation. It can improve the recovery of brain and nervous system function.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2008年第7期409-412,共4页
Chinese Critical Care Medicine
关键词
心肺复苏
肾上腺素
递增剂量
方程
氨茶碱
cardiopulmonary resuscitation
epinephrine
G=(K+2^x-1) mg/3 min(K=l, 2, n=1, 2 5, G≤0.2 mg/kg)
graduate increased dosage
equation aminophyline