摘要
目的观察应用酚妥拉明和多巴胺治疗心肺复苏术(CPR)成功患者的疗效及安全性。方法选择2008年5月—2013年1月本院因心搏骤停需行紧急CPR的患者58例,将其按随机数字表法分为研究组(28例)和对照组(30例)。两组患者均给予扩充血容量、升高血压等常规治疗,研究组加以酚妥拉明和多巴胺治疗。所有患者于CPR成功后1、5、15、30 d取静脉血,采用快速荧光免疫法检测N-末端脑钠肽前体(NT-proBNP),并行心脏彩色超声检查心功能指标;于CPR成功后12、24、48、72、96 h测定肌酸激酶同工酶(CK-MB)。结果以CPR成功为始点,CPR成功后30 d后为终点,有8例患者因家属放弃而退出,其中对照组6例,研究组2例。研究组有7例(26.9%)患者因再次心搏骤停抢救无效死亡,对照组有9例(37.5%)因再次心搏骤停抢救无效死亡,研究组CPR成功后病死率低于对照组(P<0.05)。两组患者每搏量(SV)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、NT-proBNP在CPR成功后1、5、15、30 d时差异均有统计学意义(P<0.05)。组间比较显示,SV、LVEF、LVESD、LVEDD在CPR成功后15、30 d研究组高于对照组(P<0.05),NT-proBNP在CPR成功后15、30 d研究组低于对照组(P<0.05);组内比较显示,两组患者SV、LVEF、LVESD、LVEDD及血中NT-proBNP水平在CPR成功后不同时间点比较,差异均有统计学意义(P<0.05)。两组患者CPR成功后血中CK-MB水平逐渐下降,但研究组CPR成功后12、24、48、72、96 h血中CK-MB水平均低于同时间点的对照组(P<0.05)。研究组未出现明显低血压等不良反应。结论应用酚妥拉明和多巴胺能有效降低CPR成功后患者的病死率,且安全性好,提高了其生存率和生存质量。
Objective To observe the safety and curative effect of combined phentolamine and dopamine on patients who had successful cardiopulmonary resuscitation （CPR）. Methods Fifty - eight patients who needed CPR due to cardiac ar- rest （CA） admitted to this hospital from May 2008 to January 2013 were divided randomly into groups study （ n = 28）, control （ n = 30）. The groups were given blood volume expansion, blood pressure elevation and other conventional treatments, and study group given additional phentolamine and dopamine. Venous blood was taken from 2 groups on days 1, 5, 15, 30 after success- ful CPR, N - terminal brain natriuretic peptide （ NT - proBNP） detected by rapid fluorescence immunoassay, heart cardiac func- tion by color ultrasound. Creatine kinase MB （CK-MB） determined on hours 12, 24, 48, 72, 96 after CPR. Results Tak- ing CPR successfulness as starting point, 30 - day after successful CPR as ending point, 8 patients withdrew due to their families＇ abandoning （6 in study group, 2 in control group）. Seven patients in study group and 9 patients in control group died due to an- other CA. The fatality rate was lower in study group than in control group after successful CPR （P 〈 0. 05）. There was signifi- cant difference in stroke volume （ SV）, left ventricular ejection fraction （ LVEF）, left ventricular end - systolic diameter （LVESD）, left ventricular end diastolic diameter （LVEDD）, and NT -proBNP between 2 groups on days 1, 5, 15, 30 after successful CPR （P 〈 0. 05）. SV, LVEF, LVESD, LVEDD were higher in study group than in control group on days 15, 30 after successful CPR （P 〈 0. 05 ）, NT - proBNP lower （ P 〈 0.05 ）. There was significant difference in SV, LVEF, LVESD, LVEDD, NT - proBNP at different time points in 2 groups after CPR （ P 〈 0.05 ）. CK - MB decreased gradually after successful CPR in 2 groups,but lower in study group than in control group at the same time points on hours 12,24,48,72,96 after successful CPR （ P 〈 0. 05 ）. Conclusion Phentolamine and dopamine can reduce effectively patients＇ mortality after successful CPR and im- prove their survival rate and quality of life.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第2期211-213,216,共4页
Chinese General Practice
关键词
心肺复苏术
酚妥拉明
多巴胺
Cardiopulmonary resuscitation
Phentolamine
Dopamine
