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Circulation：尽早应用肾上腺素可明显提高院外心脏骤停患者的存活率

2018-05-13 MedSci MedSci原创

心脏骤停肾上腺素非休克性
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既往研究证明尽早应用肾上腺素可提高休克性初始心律性院外心脏骤停（OHCA）患者的存活率。但肾上腺素应用时间对非休克性初始心律患者的效应尚不明确。现有研究人员对肾上腺素应用时间和急救医疗服务（EMS）治疗的非休克性初始心律的OHCA成人和儿童患者的存活率的关联进行探究。研究人员对2011年6月4日-2015年6月30日复苏预后联网前瞻性鉴定的OHCAs进行二次分析。纳入EMS治疗的非休克性心律的OH

既往研究证明尽早应用肾上腺素可提高休克性初始心律性院外心脏骤停（OHCA）患者的存活率。但肾上腺素应用时间对非休克性初始心律患者的效应尚不明确。现有研究人员对肾上腺素应用时间和急救医疗服务（EMS）治疗的非休克性初始心律的OHCA成人和儿童患者的存活率的关联进行探究。

研究人员对2011年6月4日-2015年6月30日复苏预后联网前瞻性鉴定的OHCAs进行二次分析。纳入EMS治疗的非休克性心律的OHCA患者（所有年龄）。排除自主循环在10min内恢复的患者。将年龄<18岁的患者归为一个分析亚组。主要变量：急救人员到达到第一次应用肾上腺素的时间（min）；次要变量是将应用肾上腺素的时间分为早（<10min）和晚（≥10min）。主要评估指标是存活率。

EMS治疗的OHCAs共有55568例，其中非休克性心律患者有32101位患者，被纳入本次分析。早期组有12238位患者，晚期组有14517位患者，另有5346位患者未接受肾上腺素治疗。根据潜在混杂因子校正后，EMS抵到到应用肾上腺素的时间，每增加1分钟，成人患者存活的优势比降低4%，优势比 0.96（95% CI 0.95-0.98）。亚组分析对神经预后进行检测，结果与前述相似（校正优势比 0.94/min；95% CI 0.89-0.98）。与早期给予肾上腺素相比，较晚给予肾上腺素的存活比可降低18%（优势比 0.82，95%CI 0.68-0.98）。对于儿科组分析（595位患者），应用肾上腺素的时间每延迟1分钟，存活比降低9%（优势比 0.91，95% CI 0.81-1.01）。

大部分非休克性心律OHCAs患者是在EMS抵到10分钟后才应用肾上腺素。每延迟1分钟应用肾上腺素，存活率均相应降低，神经预后也更差。EMS机构应慎重考虑如何缩短非休克性心律OHCAs患者首次用上肾上腺素的时间。

原始出处：

Matthew Hansen，et al.Time to Epinephrine Administration and Survival From Nonshockable Out-of-Hospital Cardiac Arrest Among Children and Adults. Circulation. May 08，2018. https：//doi.org/10.1161/CIRCULATIONAHA.117.033067

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    2018-07-08 daviiliu

    #存活率#

    0

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    2018-06-25 xuyong523

    #肾上腺#

    0

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    2018-05-15 wwzzly

    #院外心脏骤停#

    0

  4. 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createdName=xuyong523, createdTime=Mon Jun 25 08:40:00 CST 2018, time=2018-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305662, encodeId=4404130566217, content=<a href='/topic/show?id=1787983537c' target=_blank style='color:#2F92EE;'>#院外心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98353, encryptionId=1787983537c, topicName=院外心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b96f328, createdName=wwzzly, createdTime=Tue May 15 14:40:00 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284903, encodeId=dabb12849038f, content=<a href='/topic/show?id=b67d8244123' target=_blank style='color:#2F92EE;'>#肾上腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82441, encryptionId=b67d8244123, topicName=肾上腺素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Tue May 15 14:40:00 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315229, encodeId=dc6a3152293a, content=好知识值得借鉴!, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Tue May 15 06:45:55 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315044, encodeId=11c8315044f7, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:16:12 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315043, encodeId=3ed5315043e6, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:15:46 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315034, encodeId=d932315034f7, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/05/12/7527595c6da2c64bc16ca23195a3828e.jpg, createdBy=b33e2353405, createdName=Vita Liang, createdTime=Mon May 14 13:11:34 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315000, encodeId=3f7331500078, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Mon May 14 09:10:14 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314999, encodeId=5739314999b7, content=心肺复苏中****的用法, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Mon May 14 09:06:40 CST 2018, time=2018-05-14, status=1, ipAttribution=)]
    2018-05-15 amyloid

    #肾上腺素#

    0

  5. 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createdName=xuyong523, createdTime=Mon Jun 25 08:40:00 CST 2018, time=2018-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305662, encodeId=4404130566217, content=<a href='/topic/show?id=1787983537c' target=_blank style='color:#2F92EE;'>#院外心脏骤停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98353, encryptionId=1787983537c, topicName=院外心脏骤停)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b96f328, createdName=wwzzly, createdTime=Tue May 15 14:40:00 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284903, encodeId=dabb12849038f, content=<a href='/topic/show?id=b67d8244123' target=_blank style='color:#2F92EE;'>#肾上腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82441, encryptionId=b67d8244123, topicName=肾上腺素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Tue May 15 14:40:00 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315229, encodeId=dc6a3152293a, content=好知识值得借鉴!, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Tue May 15 06:45:55 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315044, encodeId=11c8315044f7, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:16:12 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315043, encodeId=3ed5315043e6, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:15:46 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315034, encodeId=d932315034f7, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/05/12/7527595c6da2c64bc16ca23195a3828e.jpg, createdBy=b33e2353405, createdName=Vita Liang, createdTime=Mon May 14 13:11:34 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315000, encodeId=3f7331500078, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Mon May 14 09:10:14 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314999, encodeId=5739314999b7, content=心肺复苏中****的用法, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Mon May 14 09:06:40 CST 2018, time=2018-05-14, status=1, ipAttribution=)]
    2018-05-15 zb1235672

    好知识值得借鉴!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1862926, encodeId=eb5f186292623, content=<a href='/topic/show?id=b5ca453451f' target=_blank style='color:#2F92EE;'>#存活率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45345, encryptionId=b5ca453451f, topicName=存活率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5b3f89, createdName=daviiliu, createdTime=Sun Jul 08 11:40:00 CST 2018, time=2018-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895128, encodeId=95bb1895128af, content=<a href='/topic/show?id=ce478241e0b' target=_blank style='color:#2F92EE;'>#肾上腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82417, encryptionId=ce478241e0b, topicName=肾上腺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dba135, 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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:16:12 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315043, encodeId=3ed5315043e6, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:15:46 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315034, encodeId=d932315034f7, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/05/12/7527595c6da2c64bc16ca23195a3828e.jpg, createdBy=b33e2353405, createdName=Vita Liang, createdTime=Mon May 14 13:11:34 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315000, encodeId=3f7331500078, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Mon May 14 09:10:14 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314999, encodeId=5739314999b7, content=心肺复苏中****的用法, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Mon May 14 09:06:40 CST 2018, time=2018-05-14, status=1, ipAttribution=)]
    2018-05-14 明月清辉

    谢谢分享.学习了

    0

  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:16:12 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315043, encodeId=3ed5315043e6, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon May 14 15:15:46 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315034, encodeId=d932315034f7, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/05/12/7527595c6da2c64bc16ca23195a3828e.jpg, createdBy=b33e2353405, createdName=Vita Liang, createdTime=Mon May 14 13:11:34 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315000, encodeId=3f7331500078, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Mon May 14 09:10:14 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314999, encodeId=5739314999b7, content=心肺复苏中****的用法, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Mon May 14 09:06:40 CST 2018, time=2018-05-14, status=1, ipAttribution=)]
    2018-05-14 明月清辉

    谢谢分享.学习了

    0

  8. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/05/12/7527595c6da2c64bc16ca23195a3828e.jpg, createdBy=b33e2353405, createdName=Vita Liang, createdTime=Mon May 14 13:11:34 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315000, encodeId=3f7331500078, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Mon May 14 09:10:14 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314999, encodeId=5739314999b7, content=心肺复苏中****的用法, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Mon May 14 09:06:40 CST 2018, time=2018-05-14, status=1, ipAttribution=)]
    2018-05-14 Vita Liang

    谢谢.学习了

    0

  9. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/05/12/7527595c6da2c64bc16ca23195a3828e.jpg, createdBy=b33e2353405, createdName=Vita Liang, createdTime=Mon May 14 13:11:34 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315000, encodeId=3f7331500078, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Mon May 14 09:10:14 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314999, encodeId=5739314999b7, content=心肺复苏中****的用法, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Mon May 14 09:06:40 CST 2018, time=2018-05-14, status=1, ipAttribution=)]
    2018-05-14 smartxiuxiu

    好!

    0

  10. 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    2018-05-14 flysky120

    心肺复苏中****的用法

    0

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