吸入的对昏迷中心脏停止患者大脑白质损伤的影响:随机临床试验
Ruut Laitio1, Marja Hynninen2, Olli Arola1
1Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland2Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
JAMA
|March 16, 2016
概括
吸入的气减少了心脏骤停幸存者的白质损伤,但并没有显著改善神经结果或死亡率. 需要进一步的试验来确认
科学领域:
- 神经科学
- 临床医学
- 放射学
背景情况:
- 临床前研究表明,对缺氧缺血性脑损伤具有神经保护作用.
- 人类对预防大脑损伤的有效性研究有限.
- 在医院外心脏骤停 (OHCA) 的幸存者面临二次脑损伤的风险.
研究的目的:
- 使用磁共振成像 (MRI) 评估吸入的对缺血白质损伤的影响.
- 评估使用和低温治疗的OHCA幸存者的神经结果和死亡率.
主要方法:
- 一个随机的,单盲的,第二阶段临床试验,涉及110名昏迷的OHCA幸存者.
- 患者接受了24小时的低温 (33°C) 或单独低温的吸入式.
- 通过扩散张力MRI (微分异位) 评估白质损伤;神经学结果和死亡率是次要终点.
主要成果:
- 克森组的总分离异性变异率增加了3. 8%,表明白质损伤较小 (P=. 006).
- 在6个月后,两组之间没有观察到神经结果 (修改的兰金表) 的显著差异.
- 在异组中观察到6个月死亡率下降的趋势 (调整后的危险率为0.49;P=.053).
结论:
- 与单独的低温相比,吸入的与低温相结合会减少OHCA幸存者的白质损伤.
- 这项研究没有显示出神经结果或死亡率的统计学上显著改善.
- 为了验证这些初步发现并评估临床疗效,需要进行更大规模,更强大的试验.
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