在心脏骤停后对损伤的血压和氧气目标
Sebastian Buhl Rasmussen1, Karoline Korsholm Jeppesen2, Jesper Kjaergaard3,4
1Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark.
Circulation
|October 4, 2023
概括
心脏骤停后的平均动脉血压低和氧气目标增加轻度急性损伤 (AKI) 的风险. 这种组合在复苏患者中没有影响严重的AKI或长期功能.
科学领域:
- 危急护理医学
- 肝脏病学
- 心脏病学
背景情况:
- 急性损伤 (AKI) 是医院外心脏骤停 (OHCA) 的常见并发症.
- 最佳的血压和氧化后护理目标,以防止心血管炎,目前尚不清楚.
研究的目的:
- 调查不同平均动脉血压 (MAP) 和动脉氧气 (PaO2) 目标对OHCA后AKI发展的影响.
- 确定MAP和PaO2的特定组合是否影响AKI的风险和严重程度.
主要方法:
- 一个随机的2x2因子试验的子研究,涉及789名昏迷的成年OHCA幸存者.
- 患者的MAP目标为63mmHg或77mmHg,PaO2目标为9-10kPa或13-14kPa.
- 在至少存活48小时的患者中使用KDIGO分类来评估AKI (N=759).
主要成果:
- 低MAP目标 (63 mmHg) 与高氧目标 (PaO2 13-14 kPa) 相结合,显著增加了轻度AKI的风险 (KDIGO第一阶段).
- 在该组中,AKI的调整后几率比为1. 87 (95% CI,1. 21-2. 89).
- 两组之间没有观察到严重的AKI阶段或其他结局的显著差异.
结论:
- 在OHCA后,低MAP和自由氧化目标的结合与较高的轻度AKI发病率有关.
- 这些特定目标并没有导致更严重的损伤或长期功能障碍.
- 进一步的研究可能会完善OHCA幸存者的最佳血液动力和氧化策略.
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