文章詳目資料

臺灣急診醫學會醫誌

  • 加入收藏
  • 下載文章
篇名 末期腎臟病合併高血押的到院前心跳停止病人存活率較佳
卷期 13:1
並列篇名 Patients with End-stage Renal Disease and Hyperkalemic Out-of-hospital Cardiac Arrest Have Improved Survival
作者 尤嘉宏蔡旻珊馬惠明方震中陳石池蔡光超李建璋
頁次 1-9
關鍵字 out-of-hospital cardiac arrestcomorbidityhyperkalemiasurvivalresuscitation到院前心肺停止併發症高血押存活率復甦TSCI
出刊日期 201103

中文摘要

目的:評估到院前心跳停止的病患中是否末期腎臟疾病患者合併高血押有較佳的存活率。
方法:回溯性世代研究由兩百三十四位成功復甦'並且存活超過24小時的非創傷性到院前心跳停止成人患者。臨床資料的來源是從急診以及加護病房使用標準紀錄格式紀錄,結果指標定義為90天存活率。單變項分析中,類別變項便用卡方檢驗,連續變項便用Mann-Whitney U檢驗:多變項分析使用Cox回歸模型。
結果:在修正了潛在性千擾困素後,我們發現因為嚴重高血押所造成的到院前心跳停止有較佳的90天存活率(危險比,95%信賴區問: 0.25 ' 0.14-0.63)。其他重要的不良預後困子包括肝硬化(3.14 ' 1.28-7.67),較久的CPR時間孟加分鐘(l品, 1.22-2.68),惡性腫瘤(1.72' 1.11-2.66)。而急救成功後在24到48小時中,最佳的格拉斯哥昏迷指數已三5(0.21' 0.05-0.86) ,困呼吸問題造成的到院前心跳停止(0.55' 0.36-0.85) ,在恢復自發性循環後平均動脈壓孟100毫米汞柱(0.59' 0.40-0.87) ,呈現無脈搏電活動節律(0.6' 0.1-0.63) ,被認為是有利的預後困子。
結論:本研究結果表明病患原本的疾病及合併症和造成心跳停止的原因對於存活率有很大的影響。在最初24小時內存活的末期腎臟病患合併高血押的到院前心跳停止病人,可能有較佳的存活率。此結論需要進一步的前瞻性研究加以確認。

英文摘要

Objective: To evaluate whether end-stage renal disease (ESRD)-related hyperkalemic arrest is associated with better survival in patients successfully resuscitated after out-of-hospital cardiac arrest (OHCA).
Methods: The retrospective cohort consisted of 224 adult, non-trauma patients who were successfully resuscitated after OHCA and survived for > 24 hours. Clinical data from emergency department (ED) and intensive care unit (ICU) medical records were recorded on a standard form. Outcome variables were defined as 90-day survival. Univariate analysis was done using chi-square tests or Mann-Whitney U tests, as indicated. ultivariate analysis was done using Cox-proportional regression model. Results: After adjusting for potential confounders, we found that OHCA caused by ESRD-related hyperkalemia was associated with better 90-day survival (HR=0.25, 95% CI: 0.14-0.63). Other adverse prognostic factors include liver cirrhosis (HR=3.14, 95% CI: 1.28-7.67), CPR duration ≥ 20 min (HR=1.81, 95% CI: 1.22-2.68), underlying malignancy (HR=1.72, 95% CI: 1.11-2.66). Best Glasgow Coma Scale score 24-48 hours after ROSC ≥ 5 (HR=0.21, 95% CI: 0.05-0.86), OHCA caused by respiratory events (HR =0.55, 95% CI: 0.36-0.85), mean arterial pressure after ROSC ≥ 100 mm Hg (HR 0.59, 95% CI: 0.40-0.87), and presenting rhythm of pulseless electric activity (HR=0.6, 95% CI: 0.1-0.63) were found to be favorable prognostic indicators.
Conclusions: Our results indicate that the underlying comorbidity and the etiology of arrest have a great influence on survival. Patients with OHCA due to severe hyperkalemia who survive the initial 24 hours may have better survival.

相關文獻