小児性心停止後の低温療法
Dermot R Doherty1, Christopher S Parshuram, Isabelle Gaboury
1Department of Anaesthesia, Division of Pediatric Intensive Care, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada.
Circulation
|March 11, 2009
まとめ
小児性心停止後の低温治療は,調整された分析では有意な死亡率の違いを示さなかった. この重症治療介入の利益と害を確認するために,さらなるランダム化試験が必要である.
科学分野:
- 小児重症病棟医療 幼児重症病棟医療
- 心血管研究 循環器科の研究
- 治療性低温症による
背景:
- 低体温治療は,心臓発作と出産時の窒息症の後の成人および新生児のアウトカムを改善することが証明されています.
- 心停止を経験した小児患者の低体温治療の有効性は未決定のままです.
- この研究は,小児性心臓発作の生存者に対する低体温治療の影響を調査しています.
研究 の 目的:
- 心停止後の小児および乳児における治療性低体温症の有効性と安全性を評価する.
- 低体温治療が,小児性心停止患者の死亡率と機能的アウトカムに影響を与えるかどうかを判断する.
主な方法:
- 2年間にわたって5つのセンターで心停止した222人の小児患者を分析したレトロスペクティブ研究です.
- 適格性の基準には,受胎後40週間以上から18歳未満の年齢,心停止>3分,蘇生後の生存>12時間が含まれていました.
- 29人の患者が低体温治療を受けた (目標温度33.7°C ~21時間);結果は,ノルモサーミア治療を受けた患者と比較された.
主要な成果:
- 低体温治療を受けた患者は,心停止期間が長くなり,より多くの介入が必要になりました.
- 調整されていない分析では,低体温症群の死亡率が高かった (P=0.009).
- 心停止の持続時間やECMOの使用などの要因を調整した後,死亡率 (P=0.502) や有害事象の有意な違いは観察されなかった.
結論:
- 治療性低体温は,高リスクの小児心停止症例で投与され,調整されていない結果を潜在的に混乱させました.
- 調整された分析では,この集団における低体温治療の利点を確認または反証することができなかった.
- ランダム化制御試験は,小児心停止後の低体温治療の利点とリスクを決定的に評価するために不可欠です.
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