低溫治療於改善到院前心跳停止病人存活率之 應用-以台灣中部某醫學中心為例

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题名:	低溫治療於改善到院前心跳停止病人存活率之應用-以台灣中部某醫學中心為例 Application of hypothermia therapy to improve the survival rate of patients with cardiac arrest before hospitalization- An Example of a Medical Center in Middle Taiwan
作者:	柯伯彥 Ko, Po-Yen
贡献者:	生物資訊與醫學工程學系
关键词:	到院前心跳停止;經皮冠狀動脈介入治療;低溫療法 Therapeutic hypothermia;Out-of-hospital cardiac arrest;Percutaneous coronary intervention
日期:	2022-07-18
上传时间:	2022-10-31 02:53:42 (UTC+0)
出版者:	亞洲大學
摘要:	Background: 近年來，低溫治療(therapeutic hypothermia, TH)已廣被用於改善到醫院前的心跳停止(Out-of-Hospital Cardiac Arrest, OHCA)病人之預後。儘管目前治療指引中有如此，即便在醫學中心，低溫治療仍然無法廣泛的推廣及應用在各個醫院。因此在我們的這項研究中，評估了對於到院前心跳停止病患使用低溫治療對臨床預後的影響。Methods: 此研究共收錄58名疑似因心臟問題導致到院前心跳停止而且經過急救後恢復自發性循環的患者。在接受低溫治療的23名患者中，在急診室先給予了大量灌注4 ℃生理食鹽水溶液，至加護病房時再給予傳統冰毯使用，使用耳膜溫度計量測體溫並維持體溫在32-34℃之間。對照組患者在沒有使用低溫治療的傳統支持療法下，比較出院時存活率及神經學功能的差異。Results: 兩組病患在性別、年齡、潛在病因和疾病嚴重程度方面皆無顯著差異。接受低溫治療的23位病患當中，有17人存活出院，而在未接受低溫治療的35位病患，只有11人存活出院 (73.91% vs. 31.43%, p = 0.0015) 。在接受低溫治療的病患中，接近 52% 的患者出院時有良好的神經學預後 (12 of 23) ，而未接受低溫治療的病人中，有約 20% (7 of 35) 有良好的神經學預後 (p = 0.01) 。Conclusions: 低溫治療可以改善到院前心跳停止患者預後。需要進一步的大規模研究來驗證我們的結果。 Background: Recently, therapeutic hypothermia (TH) has been used toimprove outcomes in patients with ambulatory cardiac arrest (OHCA).Despite these recommendations, many centers are still reluctant toimplement these hypothermia protocols. In this research, the effect of THon OHCA patients was evaluated.Methods: Included in a total of 58 OHCAs that spontaneously returnedfrom OHCA for cardiac reasons. Twenty-three patients underwent THwith a large number of ice crystals in the intensive care unit and aconventional cooling blanket in the emergency room and maintained theirbody temperature at 32-34°C for 24 hours using a control thermometer.Patients in the control group received no TH but standard supportive care.We compared hospital survival and neurological outcome.Results: Including patient characteristics, underlying etiology, anddisease severity, there were no significant differences between the twogroups. Of the 23 patients who received TH, 17 survived to discharge. Ofthe 35 patients who received supportive care, 11 eventually survived tohospital discharge (73.91% vs 31.43%, p = 0.0015). Fifty-two percent ofpatients in the TH group showed good neurological outcomes (12/23)compared to 20% (7/35) in the control group (p = 0.01).Conclusions: TH can improve the outcomes of OHCA patients. Furtherlarge-scale studies are needed to verify our results.
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