血压目标对心力衰竭患者进行复苏后护理的影响:来自随机对照试验的亚组分析
Johannes Grand1,2, Christian Hassager1,3, Henrik Schmidt4
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark (J.G., C.H., B.N., L.E.R.O., M.A.S.M., J.J., R.P.B., J.E.M., J.K.).
Circulation. Heart failure
|June 7, 2024
概括
针对心力衰竭心率增加的心脏病患者中较高的平均动脉压 (MAP) 的向,但没有显著改变心脏指数或存活率. 这表明,在这个弱势群体中,要仔细考虑MAP目标.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 复苏科学复苏科学 复苏科学
背景情况:
- 昏迷症患者患有医院外心脏骤停 (OHCA) 和心力衰竭 (HF) 史,在复苏后的护理中存在独特的挑战.
- 优化血液动力学管理,特别是血压目标,对于改善这种患者子组的结果至关重要.
研究的目的:
- 评估针对较高与较低的平均动脉压 (MAP) 对血液动力学参数和临床结果的影响,在有HF史的OHCA患者中.
- 调查不同MAP目标对心脏指数,左心室喷射率和死亡率的影响.
主要方法:
- 随机双盲BOX试验的一项子研究包括了134名具有HF病史的OHCA患者.
- 在复苏后的重症监护期间,患者被分配到63 mm Hg或77 mm Hg的目标MAP.
- 评估了血液动力学数据 (心脏指数,喷射率,心率,中风量) 和临床结果 (脏替代疗法,死亡率).
主要成果:
- 在前72小时内,在MAP63和MAP77组之间没有观察到心脏指数的显著差异 (平均差异为0.15L/min·m-2;P=0.22).
- 在MAP77组的患者经历了显著增加的心率 (平均差异为6次/分钟;P=0.03) 和更高的血管压缩剂使用.
- 左心室喷射率和中风体积在各组之间是相似的. 365天死亡率的调整后危险比为1.38 (P=0.20).
结论:
- 在有过高血压史的OHCA患者中,较高的MAP目标 (77 mm Hg) 导致心率增加,但没有改善心率指数,左心室喷射率或中风体积.
- 该研究发现,在较高和较低的MAP目标群体之间,在365天的死亡率或脏替代疗法中没有确定的差异.
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