心停止から蘇生後の早期高酸素暴露と神経障害との関連:前向きの多センタープロトコル指向コホート研究
Brian W Roberts1, J Hope Kilgannon1, Benton R Hunter2
1Department of Emergency Medicine (B.W.R., J.H.K., S.T.).
Circulation
|February 14, 2018
まとめ
心停止の蘇生後の高酸素レベルへの早期曝露は,より悪い神経学的結果と関連しています. この研究では,高酸素症 (Pao2 > 300 mm Hg) が,退院時に神経機能の低下と独立して関連していることが判明しました.
科学分野:
- 心臓病科
- 神経学
- クリティカル ケア 医療
背景:
- 心停止後の高酸素症の暴露と患者のアウトカムに関して矛盾する結果があります.
- 早期の蘇生後の高酸素症は神経学的回復に悪影響を及ぼすと推測されています.
研究 の 目的:
- 早期の蘇生後の高酸素症が 悪い神経学的結果と関連しているという仮説を検証する.
- 心停止後の様々なレベルの高酸素症と神経機能の関連性を調査する.
主な方法:
- 大人の心停止患者の多センター前向きコホート研究.
- 高酸素症は,自発的な循環が再開してから6時間以内に,動脈の酸素の部分圧 (Pao2) が300mmHgを超えると定義される.
- 病院退院時の修正ランキンスケールで評価された神経学的不良結果; 多変量回帰分析を使用した.
主要な成果:
- 280人の患者の38%が高酸素症を経験し,高酸素症患者の77%は神経学的アウトカムが悪かった.
- 高酸素症は神経機能の低下と独立して関連していた (RR1. 23).
- ハイパーオクシアの追加1時間ごとに,神経学的悪影響のリスクは3%増加した (RR1. 03).
結論:
- 心停止の蘇生後の早期の高酸素露出は,神経機能の低下と独立して関連しています.
- 高酸素症と悪い神経学的結果との関連は,Pao2レベル300mmHg以上で観察されました.
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