肾上腺素递增剂量方程与氨茶碱及生脉注射液联合在心肺复苏中的应用

The application of the epinephrine with graduate increased dosage by the modality equation and amlnophylline and sheng-mai injection with uniform method at the same time rapidly combination on cardiopulmonary resuscitation

目的探讨肾上腺素递增剂量方程G=（K＋2^（n-1））mg／3min（K=1、2，n=1、2、3……，G≤0．2mg／kg）与氨茶碱7mg／kg及生脉注射液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328例心脏骤停患者分成3组，即标准剂量肾上腺素组（SDE组）112例、方程G=（（K＋2^（n-1））mg／3min（K=1、2，n=1、2．3……，G≤O．2mg／kg）中首次剂量K=lrag（方程1）组106例及K=2mg（方程2）组110例。同时进行心电、平均动脉压（MAP）、心率（HR）、自主循环恢复时间等监测，并评价复苏效果。结果方程2组和方程1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组比较均显著升高（P〈0．01），方程2组和方程1组CPR始用药至自主循环恢复时间与SDE组比较显著缩短（P〈0．01）。方程2组、方程1组和SDE组CPR始用药至自主循环恢复中肾上腺素用量明显减少（P〈0．05），但方程2组和方程1组达到自主循环恢复所需静脉推注肾上腺素的周期数与SDE组比较显著减少（P〈0．01）。结论采用肾上腺素递增剂量方程G=（K＋2^（n-1））mg／3min（K=1、2，n=1、2．3……，G≤0．2mg／kg）和氨茶碱7mg／kg及生脉注射液．陕速同步联合应用，在CPR流程中能显著提高心脏复苏率、提高存活率，并且显著缩短自主循环恢复时间，改善神经系统及脑功能，提高复苏时效效应，是提高心、肺、脑复苏成功率的又一新方法和途径。

Objective To investigate the effects of application and clinical value of the epinephrine with graduate increased dosage by the modality equation G = （K＋2^（n-1））mg/3 min （K = 1,2, n = 1, 2, 3…… , G ≤0.2 mg/kg） and aminophylline and sheng-mai injection with uniform method at the same time rapidly eombination on cardiopulmonary resuscitation （CPR）. Methods Three hundred and twenty-eight cases with sudden cardiac-arrest （CA） were randomly divided into 3 groups： 112 cases with the standard-dose epinephrine group （SDE control group）; 106 cases with the first-dosage epinephrine for K = 1 mg in the equation G = （K＋2^（n-1）） mg/3 min （K = 1, 2, n = 1, 2, 3 ,G≤0.2 mg/kg, group （equation 1 group） and 110 cases with the first-dosage epinephrine for K = 2 mg （epuation 2 group）. Patients＇ electrocardiogram and mean arterial pressure （MAP） and the heart rate （HR） and the time of recovery of spontaneous circulation （ROSC）were monitored, and the resuscitation effect were evaluated. Results To compare the equation 2 group and equation 1 group with the SDE control group, the ROSC rate, the survival rate, the 24-hour survival rate and the scoring by Glasgow coma scale were all significantly elevated （P 〈 0.01 ）; but the average time from initial stage applied with the epinephrine in the CPR to ROSC in the equation 2 group and equation 1 group was much shorten significandy than that in the SDE control group （P 〈 0.01 ）. To compare the equation 2 group and equation 1 group with the SDE control group： the average dose of the epinephrine was much reduced from initial stage applied with the epinephrine on CPR to ROSC （P〈 0.05）, but the cycle summation of application epinephrine by mainhne from the CPR initial stage to ROSC in the equation 2 group and equation 1 group was much significantly decreased than that in the SDE control group （P 〈 0.01 ）. Conclusions The method of the epinephrine with graduate increased dosage by the equation G=（K＋2^（n-1）） mg/3 min（K = 1, 2, n = 1, 2, 3 , G≤0.2 mg/kg） and aminophylline and sheng-mai injection with uniform method at the same time rapidly combination on CPR has better effects on increasing significantly the success rate of CPR, the survival rate, the time activity of success and shortening significantly time of the ROSC, improving brain and nervous system function. It can be new and effective method to increasing the success rate of resuscitation on the CPR.