亚低温治疗对院内心脏停搏患者神经功能和预后的影响

The Impact of Mild Therapeutic Hypothermia on Neurologic Function and Prognosis in Patients with In-hospital Cardiac Arrest

目的探讨亚低温治疗对院内心脏停搏心肺复苏（CPR）后昏迷幸存者神经功能和预后的影响。方法51例室颤所致的心脏停搏患者，在心肺复苏成功自主循环恢复后，随机接受亚低温治疗（中心体温降至32-34℃，并维持24h）或常温治疗。比较两组患者复苏后第1d、3d和7d时GCS评分以及6个月时神经功能良好率和病死率。结果在心肺复苏后第7天，亚低温组患者GCS评分明显高于常温组（P〈0．05）；在复苏后6个月，亚低温组53．8％（14／26）患者神经功能良好（脑功能分级为1或2），明显高于常温组24％（P=0．029）；亚低温组6个月时病死率为34．6％（9／26），明显低于常温组64％（P=-0．036）。结论亚低温治疗有助于改善院内心脏停搏心肺复苏后幸存者的神经功能，降低病死率。

Objective To assess the effect of mild therapeutic hypothermia on neurologic function and mortality in comatose survivors of in-hospital cardiac arrest. Methods Patients who had been resuscitated after cardiac arrest due to ventricular fibrillation were randomly assigned to receive mild therapeutic hypothermia （with the core body temperature reduced to 32℃to 34℃ and maintained for 24 hours） or normothermia. The Glasgow coma scale（GCS） score within seven days after cardiopulmonary resuscitation（CPR）, A favorable neurologic outcome and mortality within six months after cardiac arrest were assessed. Results Seven days after CPR, the GCS score of patients in hypothermia group was higher than that in normothermia group（P〈 0.05）. Fourteen of 26 patients in hypothermia group （53.8%） had a favorable neurologic outcome （cerebral performance category, 1 [good recovery] or 2 [moderate disability]） ,as compared with 6 of 25 （24%） in the normothermia group （P=0.029）. Mortality at six months was 34.6 % in the hypothermia group （9 of 26 patients died）, as compared with 64 % in the normothermia group （P=0.036）. Conclusions This study demonstrated that mild therapeutic hypothermia helped improve neurologic outcomes and reduce mortality of comatose survivors of in-hospital cardiac arrest.