心筋梗塞を合併させる心臓ショックにおける軽度の低温症
Georg Fuernau1,2,3, Johannes Beck3, Steffen Desch1,2,3
1Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig-Holstein (G.F., S.D., I.E., A.J., S.d.W.-T), University of Luebeck, Germany.
Circulation
|July 21, 2018
まとめ
軽度の治療性低体温は,急性心筋梗塞の患者で心臓ショックを改善しませんでした. この研究では,血動力学的に有意な効果は認められず,この特定の患者群では有益な治療法ではないことを示しています.
科学分野:
- 心臓病科
- クリティカル ケア 医療
- 治療用 低温症
背景:
- 実験データによると,軽度の治療性低体温症 (MTH) は,心筋梗塞 (MI) の後の心血管ショックの結果を改善する可能性がある.
- しかし,この特定の集団における血液動力学的効果に関する確固たる臨床的証拠は欠けていた.
- この研究は,MTHが急性心筋梗塞を合併する心筋梗塞の管理における役割を明らかにすることを目的とした.
研究 の 目的:
- 急性心筋梗塞 (MI) の後に心筋性ショックを経験した患者の軽度の治療性低体温 (MTH) の血液動力学的効果を調査する.
- MTHが心動力指数や他の血液動力学的パラメータに与える影響を評価する.
- MTHで治療された患者の動脈乳酸濃度と30日間の死亡率を評価する.
主な方法:
- 発作後心筋梗塞を患った40人の患者によるランダム化対照試験
- 患者は,24時間MTHまたは標準治療 (対照群) を受けるために1:1でランダムに割り当てられました.
- 主なエンドポイントは24時間後の心動力指数で,二次的なエンドポイントは他の血液動力学的測定値と動脈乳酸であった.
主要な成果:
- MTHと対照群の間では,24時間後の第一評価値である心電量指数において有意な差は認められなかった (0. 41対0. 36W/ m2; P=0. 50).
- 血液動力学的測定値と30日間の死亡率 (60%対50%;P=0. 55) は,グループによって統計的に異なるものではありませんでした.
- MTH群では血流乳酸濃度が著しく高く,減速が遅かった (相互作用のP=0. 03).
結論:
- 軽度の治療性低体温は,心筋梗塞後の心臓ショック患者で24時間後に心筋力指数に実質的な有益な効果を示さなかった.
- この患者群では,MTHが血液動力学的機能の改善に有効な介入ではないことを示唆している.
- MTHから恩恵を受ける特定のサブグループを特定するには,さらなる研究が必要かもしれません.
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