在非医院心脏骤停后发生急性损伤
Karoline Korsholm Jeppesen1,2, Sebastian Buhl Rasmussen3,2, Jesper Kjaergaard4,5
1Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000, Odense C, Denmark.
Critical care (London, England)
|May 18, 2024
概括
在非医院心脏骤停 (OHCA) 后的急性损伤 (AKI) 显著降低了1年生存率. 连续脏替代疗法 (CKRT) 的和没有连续脏替代疗法 (CKRT) 的两种AKI都独立地与更糟糕的结果有关,无论停顿前的情况如何.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
背景情况:
- 急性损伤 (AKI) 是已知的死亡风险因素在医院外心脏骤停 (OHCA).
- 在OHCA后,AKI严重程度对长期存活的独立贡献,除了与围捕状况的关联之外,仍然不完全理解.
研究的目的:
- 调查AKI的发展和严重程度与昏迷成年OHCA幸存者的1年整体存活率之间的关联.
- 确定AKI是否代表OHCA后死亡的独立风险因素.
主要方法:
- 一项随机试验的子研究包括759名昏迷的OHCA患者,这些患者在没有先前透析依赖的情况下恢复了生命.
- 使用KDIGO标准对AKI进行分类,将患者分为没有AKI,没有CKRT的AKI和具有CKRT组的AKI.
- 调整后的考克斯比例危险模型评估了基于AKI组的365天总生存期.
主要成果:
- 33.5%的患者发生AKI (n=254),其中77人需要持续置换疗法 (CKRT).
- 患有AKI的患者,特别是需要CKRT的患者,经历了更长的时间恢复自发循环 (ROSC) 和更严重的代谢障碍.
- 总体而言,365天的生存率随着AKI严重程度的增加而下降. 经过调整后的分析显示,AKI (有或没有CKRT) 与降低生存率 (HR 1.75-1.76) 有显著关联.
结论:
- 在OHCA之后,AKI的发展,无论CKRT的要求如何,都与1年生存率明显降低有关.
- 即使在调整其他停顿前风险因素后,AKI和降低生存率之间的关联仍然存在,这表明AKI是死亡率的独立预测因素.
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