摘要
目的探索早期不同补液策略对院外心脏骤停(OHCA)患者恢复自主循环(ROSC)后30 d生存结局的影响。方法回顾性收集美国重症医学信息数据库(MIMIC-IV 2.2)中2008年—2019年间急诊记录的OHCA患者数据,筛选出实现ROSC并入住重症监护病房患者的一般资料。根据入院6 h内接受的静脉补液量,将患者分为常规补液组(≤30 mL/kg)和开放性补液组(>30 mL/kg)。主要研究终点为30 d全因死亡率。应用多变量Cox回归、倾向性评分分析以及限制性立方样条回归,评估两种补液策略的差异。结果共纳入262例患者,其中常规补液组136例,开放性补液组126例。与常规补液组相比,接受开放性补液组的患者初始心律可除颤比例更低(27.8%vs.41.2%,P=0.032),目击者比例更低(60.3%vs.75.7%,P=0.011)以及旁观者实施心肺复苏(CPR)比例(57.9%vs.77.2%,P=0.001)也更低,此外,该组患者在复苏过程中肾上腺素使用剂量更大,6 h乳酸清除率更低。与开放性补液组相比,常规补液组既往有心功能不全(18.4%vs.9.5%,P=0.06),高血压(63.2%vs.49.2%,P=0.03)、冠心病(36.8%vs.15.1%,P<0.001)的比例更高。经多变量Cox回归调整混杂因素后,结果显示开放性补液与患者30 d死亡风险增加独立相关(OR=1.495,95%CI:1.085~2.061,P=0.014),倾向性评分匹配后的队列观察到一致的结果(OR=1.847,95%CI:1.242~2.746,P=0.002)。Kaplan-Meier生存分析显示,两组患者30 d存活率具有显著差异(log-rank test,P<0.01),匹配后的队列显示出相似的结果(log-rank test,P=0.002)。限制性立方样条回归分析表明,当早期静脉补液量超过29 mL/kg时,患者30 d的死亡风险随补液量增加而显著升高。结论早期开放性补液与OHCA患者30 d死亡风险增加独立相关,提示临床实践中采用谨慎的补液策略可能对患者的预后有益。
Objective To investigate the effects of different early fluid resuscitation strategies on the 30-day survival outcomes for patients who experienced out-of-hospital cardiac arrest(OHCA)and subsequently achieved return of spontaneous circulation(ROSC).Methods A retrospective analysis of emergency 0HCA patient data from the MIMIC-IV 2.2 database,spanning 2008 to 2019,was conducted.Patients who achieved ROSC and were admitted to the intensive care unit were selected for the study.Based on the volume of intravenous fluids received within the first 6 hours of admission,categorized into standard fluid resuscitation group(<30 mL/kg)and liberal fluid resuscitation group(>30 mL/kg).The.primary endpoint was the 30-day all-cause mortality rate.Multivariate Cox regression,propensity score analysis,and restricted cubic spline regression were employed to assess the differences between the two fluid resuscitation strategies.Results A total of 262 patients were included in the study,with 136 in the standard fluid resuscitation group and 126 in the liberal fluid resuscitation group.Compared with the conventional fluid resuscitation group,patients in the open fluid resuscitation group had a lower proportion of defibillation(27.8%vs.41.2%,P=0.032),a lower proportion of witnesses(60.3%vs.75.7%,P=0.011),and a lower propotion of bystander cardiopulmonary resuscitation(CPR)(57.9%1s.77.2%,p=0.001).In addition,patients in this group had a higher dose of epinephrine during resuscitation and a lower 6-hour lactate clearance rate.Compared with the open rehydration group,the proportion of patients with previous cardiac insufficiency(18.4%vs.9.5%,P=0.06),hypertension(63.2%vs.49.2%,P=0.03),and coronary heart disease(36.8%vs.15.1%,P<0.001)was higher.After adjusting for confounders using multivariate Cox regression,liberal fluid resuscitation was independently associated with an increased risk of 30-day mortality(OR=1.495,95%CI:1.085-2.061,P=0.014).A consistent outcome was observed in the propensity score-matched cohort(OR=1.847,95%CI:1.242-2.746
作者
韩冉
韩东
赵宁军
花嵘
苏成磊
燕宪亮
HAN Ran;HAN Dong;ZHAO Ningjun;HUA Rong;SU Chenglei;YAN Xianliang(Emergency Medicine Department,the Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221000,China)
出处
《中国急救复苏与灾害医学杂志》
2024年第10期1288-1293,共6页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
国家自然科学基金(编号:82202426)
江苏省自然科学基金(编号:BK20220674,BK20231162)
徐州市青年医学科技创新项目(编号:XWKYHT20210571)。
