快速同步氨茶碱与肾上腺素联合在心肺复苏中的应用价值研究

The application value study of the aminophylline and epinephrine with uniform method at the same time and rapidly combination on cardiopulmonary resuscitation

目的探讨快速同步氨茶碱与肾上腺素联合在心肺复苏中的应用效果及临床价值。方法把398例心跳骤停（CA）患者随机分成三组：标准剂量肾上腺素（SDE）对照组130例、大剂量肾上腺素（HDE）组132例、快速同步氨茶碱与肾上腺素联合应用（ADE）组136例。采用肘静脉通道应用肾上腺素和氨茶碱：（I）SDE对照组采用1mg首次剂量肾上腺素静脉注射无效后。每间隔3min快速重复1次首次剂量。（2）HDE组，采用0．1mg／kg肾上腺素作为首次剂量。无效后每间隔3min重复1次首次剂量。（3）ADE组，快速采用同步氨茶碱10mg／kg和肾上腺素1mg作为首次剂量静脉注射，若无效后，每间隔3min重复1次首次剂量，同时对心电图、平均动脉压、心率、自主循环恢复的时间等进行监测，并进行复苏效果的评价。结果（1）ADZ组和HDE组自主循环恢复率、24h存活率、出院存活率、出院存活Glasgow昏迷评分与SDE对照组比较均显著升高。（2）ADE组肾上腺素平均用量明显比HDE组减少，但自主循环恢复率、24h存活率、出院存活率明显升高。结论快速同步氨茶碱与肾上腺素联合应用在心肺复苏中能明显提高心肺复苏自主循环恢复率、提升存活率并且能显著缩短自主循环恢复时间，是提高心、肺、脑复苏成功率的新的方法和途径。

Objective To investigate the effects of application and clinical value of the aminophylline and epinephrine with uniform speed at the same time by rapidly intravenously on cardiopulmonary resuscitation （CPR）. Methods Three hundred and ninety-eight cases with sudden cardiac-arrest （CA） were randomly divided into 3 groups. One hundred and thirty cases with the Standard-dose epinephrine group （ SDE control group）, 132 cases with the high-dose epinephrine group （HDE group）, 136 cases with the aminophylline and epinephrine by uniform method combination group （AI）E group）. To apply aminophylline and epinephrine with elbow vein passage by subseqent methods： （1）If it was frustrane for SDE group apply epinephrine with the first-dose 1 mg by intravenous injection that must be echo apply the first dosage every time interval 3 minutes. （2）If it was frustrane for HDE group apply epinephrine with the first-dose 0.1 mg/kg by intravenous injection that must be echo apply the first dosage every time interval 3 minutes. （3）If it was frustrane for ADE group apply aminophylline with the first-dose 10 mg/kg and epinephrine with the first-dose 1 mg by quickly combination by intravenous injection that must be echo apply the first-dose every time interval 3 minutes. In the three groups, electrocadiogram and mean arterial pressure （MAP） and the heart rate （HR） and the time of recovery of spontsneous circulation were monitored and the resuscitation effect was evaluated. Results （1）To compare the ADE and HDE groups with the SDE control group, the recovery of spontaneous circulation （ROSC） rate, the survival of rate 24 hours, the survival of rate dischare hospital and the scoring by Glasgow coma scale were all significantly elevated （P〈0.01 ）. （2）To compare the ADE group with the HDE group, the average dose of the epinephrine was much reduced from intial stage apply epinephrine on CPR to ROSC （P 〈 0.05 ）, but the ROSC rate, the survival of rate 24 hours and the survival of rate dischare hospital were all much greater （P〈0.05）. Conclusion To apply the aminophylline and epinephrine with uniform combination method has better effects on increasing segnilicantly the success rate of CPR, the survival rate, the time activity of success and shortening significantly time of the recovery of spontaneous circulation. It can be new and effective method about increasing the success rate of resuscitation on the CPR.