临床时讯 ＞ 临床研究
一项多国联合研究显示，持续高血糖症和接受抗惊厥药物治疗的癫痫发作增加院外心跳骤停患者死亡风险。在接受侵入性治疗后，出血和感染常见，但不增加患者死亡率。论文2010年10月14日在线发表于《重症医学》（Critical Care Medicine）杂志。
研究纳入2004年10月至2008年10月间22家医院院外心跳骤停患者765例。结果为，在多变量模型中，持续性高血糖症（血糖>8mmol/L（>4h），比值比（OR）=2.3，95% CI为1.6～3.6，P<0.001）和接受抗惊厥药物治疗的癫痫发作（OR=4.8，95% CI为2.9～8.1，P<0.001）与死亡率增加相关。接受侵入性治疗后，患者出血和脓毒症发生率增加，但不增加死亡率（OR分别为1.0（95% CI为0.46～2.2，P=0.91）和0.30（95% CI为0.12～0.79，P=0.01）。
Crit Care Med. 2010 Oct 14. [Epub ahead of print]
Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia.
Nielsen N, Sunde K, Hovdenes J, Riker RR, Rubertsson S, Stammet P, Nilsson F, Friberg H; the Hypothermia Network.
From the Department of Clinical Sciences (NN, HF), Lund University, Lund, Sweden; Department of Anesthesiology and Intensive Care (NN), Helsingborg Hospital, Helsingborg, Sweden; Surgical Intensive Care Unit (KS), Oslo University Hospital, Ulleval, Norway; Department of Anesthesiology (JH), Oslo University Hospital, Rikshospitalet, Norway; Department of Critical Care (RRR), Maine Medical Center, Portland, ME, U.S.A.; Department of Anesthesiology and Intensive Care (SR), Uppsala University Hospital, Uppsala, Sweden; Department of Anesthesiology and Intensive Care (PS), Centre Hospitalier de Luxembourg, Luxembourg; Competence Centre for Clinical Research (FN), Lund University, Lund, Sweden; and Department of Emergency Medicine (HF), Lund University Hospital, Lund, Sweden.
OBJECTIVES: To investigate the association between adverse events recorded during critical care and mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia.
DESIGN: Prospective, observational, registry-based study.
SETTING: Twenty-two hospitals in Europe and the United States.
PATIENTS: Between October 2004 and October 2008, 765 patients were included.
MEASUREMENTS AND MAIN RESULTS: Arrhythmias (7%-14%), pneumonia (48%), metabolic and electrolyte disorders (5%-37%), and seizures (24%) were common adverse events in the critical care period in cardiac arrest patients treated with therapeutic hypothermia, whereas sepsis (4%) and bleeding (6%) were less frequent. Sustained hyperglycemia (blood glucose >8 mmol/L for >4 hrs; odds ratio 2.3, 95% confidence interval 1.6-3.6, p < .001) and seizures treated with anticonvulsants (odds ratio 4.8, 95% confidence interval 2.9-8.1, p < .001) were associated with increased mortality in a multivariate model. An increased frequency of bleeding and sepsis occurred after invasive procedures (coronary angiography, intravascular devices for cooling, intra-aortic balloon pump), but bleeding and sepsis were not associated with increased mortality (odds ratio 1.0, 95% confidence interval 0.46-2.2, p = .91, and odds ratio 0.30, 95% confidence interval 0.12-0.79, p = .01, respectively).
CONCLUSIONS: Adverse events were common after out-of-hospital cardiac arrest. Sustained hyperglycemia and seizures treated with anticonvulsants were associated with increased mortality. Bleeding and infection were more common after invasive procedures, but these adverse events were not associated with increased mortality in our study.