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[NEJM在线发表]:肾上腺素治疗院外心跳骤停
2018年07月26日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

Gavin D. Perkins, Chen Ji, Charles D. Deakin, et al

N Engl J Med July 18, 2018

DOI: 10.1056/NEJMoa1806842

BACKGROUND 背景

Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebo-controlled trial to determine whether the use of epinephrine is safe and effective in such patients.

人们对使用肾上腺素治疗院外心跳骤停存在顾虑,导致国际复苏联合委员会呼吁进行安慰剂对照临床试验,以确定此类患者使用肾上腺素是否安全有效。

METHODS 方法

In a randomized, double-blind trial involving 8014 patients with out-of-hospital cardiac arrest in the United Kingdom, paramedics at five National Health Service ambulance services administered either parenteral epinephrine (4015 patients) or saline placebo (3999 patients), along with standard care. The primary outcome was the rate of survival at 30 days. Secondary outcomes included the rate of survival until hospital discharge with a favorable neurologic outcome, as indicated by a score of 3 or less on the modified Rankin scale (which ranges from 0 [no symptoms] to 6 [death]).

在英国进行的这项随机双盲试验纳入了8014名院外心跳骤停患者,除标准治疗外,5个NHS急救服务系统的医疗辅助人员给予了胃肠外肾上腺素(4015名患者)或生理盐水安慰剂(3999名患者)。主要预后终点为30天存活率。次要预后终点包括出院时存活且神经系统预后良好,定义为修订Rankin评分(分值范围从0分[无症状]到6分[死亡])3分或更低。

RESULTS 结果

At 30 days, 130 patients (3.2%) in the epinephrine group and 94 (2.4%) in the placebo group were alive (unadjusted odds ratio for survival, 1.39; 95% confidence interval [CI], 1.06 to 1.82; P=0.02). There was no evidence of a significant difference in the proportion of patients who survived until hospital discharge with a favorable neurologic outcome (87 of 4007 patients [2.2%] vs. 74 of 3994 patients [1.9%]; unadjusted odds ratio, 1.18; 95% CI, 0.86 to 1.61). At the time of hospital discharge, severe neurologic impairment (a score of 4 or 5 on the modified Rankin scale) had occurred in more of the survivors in the epinephrine group than in the placebo group (39 of 126 patients [31.0%] vs. 16 of 90 patients [17.8%]).

至30天时,肾上腺素组130名患者(3.2%)及安慰剂组94名患者(2.4%)存活(存活的未校正比数比,1.39;95% 可信区间 [CI],1.06 to 1.82;P=0.02)。没有证据显示两组患者出院时存活且神经系统预后良好的比例存在显著差异(4007名患者中87名 [2.2%] vs. 3994名患者中74名 [1.9%];未校正比数比,1.18;95% CI,0.86 to 1.61)。在出院时,肾上腺素组患者严重神经系统异常(修订Rankin评分4或5分)的比例显著高于安慰剂组(126名患者中39名 [31.0%] vs. 90名患者中16名 [17.8%])。

 

CONCLUSIONS 结论

In adults with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine group. (Funded by the U.K. National Institute for Health Research and others; Current Controlled Trials number, ISRCTN73485024.)

对于院外心跳骤停的成年患者,与安慰剂相比,使用肾上腺素显著提高30天存活率,但由于肾上腺素组更多存活患者出现严重的神经系统异常,因此,两组患者神经系统预后良好的患者比例没有显著差异。

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