治疗无法解释的昏迷:多中心,随机的心脏节奏试验,以腺5'-三酸盐测试为指导
Daniel Flammang1, Timothy R Church, Luc De Roy
1Health Studies Section, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, 350 McNamara Alumni Center, 200 Oak St SE, Minneapolis, MN 55455-2008, USA.
Circulation
|November 17, 2011
概括
活跃的双室节奏显著减少老年患者昏迷的复发原因不明. 这种疗法以腺三酸盐 (ATP) 测试为指导,可降低复发性昏睡的风险75%.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 临床试验 临床试验
背景情况:
- 不知来源的昏迷影响了许多老年患者,40%的患者在检查后仍未被诊断出来.
- 腺三酸盐 (ATP) 测试可以帮助确定受益于特定疗法的患者.
- 需要进行随机试验,以确认ATP引导的干预措施对昏迷的疗效.
研究的目的:
- 为了确定基于阳性ATP测试的选择心脏节奏是否会减少未知原因患者的昏迷复发.
- 为了比较活跃的双室节奏与备用节奏在预防昏迷复发中的有效性.
主要方法:
- 一个多中心,患者失明,随机优越性试验,涉及80名老年患者的昏迷来源不明和记录的心脏阻塞.
- 患者接受可编程心脏起器,并随机分配到活跃的双室节奏 (70bpm) 或备用心房节奏 (30bpm).
- 主要结局是昏迷复发,平均随访时间为16个月 (长达5年).
主要成果:
- 在21%的活跃节奏组患者中,昏迷复发,而在备用节奏组中,这一比例为66% (危险比率:0.25).
- 与备用节拍相比,主动节拍显示同步复发风险降低了75%.
- 在对照组中复发后,重新编程到主动节拍后,只导致了一个随后的昏迷事件.
结论:
- 活跃的双室节奏是非常有效的减少昏迷复发的老年患者具有积极的ATP测试.
- ATP测试可以指导节奏决策,从而显著改善昏迷管理.
- 这项研究支持使用ATP引导的活跃节奏来治疗老年人未知来源的昏迷.
相关概念视频
Cardiopulmonary Resuscitation IV: Pharmacological Management
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
Dysrhythmias VI: Management of Dysrhythmias
Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
Dysrhythmias V: Evaluating Dysrhythmias
Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
Cardiopulmonary Resuscitation III: AED Use
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...


