Thời gian điều trị epinephrine liên quan đến nguy cơ tử vong ở trẻ em đạt được hồi phục tuần hoàn tự nhiên bền vững sau ngừng tim ngoài bệnh viện do chấn thương

Critical Care - Tập 23 Số 1 - 2019
Yenn-Jiang Lin1,2,3, Meng-Huan Wu4, Tren-Yi Chen1, Yuan-Jhen Syue5, Mei-Chueh Yang1, Tsung‐Han Lee1, Chih‐Ming Lin6,7,8, Chu-Chung Chou1,2,3, Chin-Fu Chang1, Chao-Jui Li4,9
1Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
2School of Medicine, Chung Shan Medical University, Taichung, Taiwan
3School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
4Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
5Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
6Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua, Taiwan
7Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
8Department of Social Work and Child Welfare, Providence University, Taichung, Taiwan
9Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung, Taiwan

Tóm tắt

Tóm tắt Đề cương Các lợi ích của việc sử dụng epinephrine sớm ở trẻ em bị ngừng tim ngoài bệnh viện không do chấn thương đã được báo cáo; tuy nhiên, các tác động trong trường hợp trẻ em bị ngừng tim ngoài bệnh viện do chấn thương vẫn chưa rõ ràng. Vì dược động học liên quan đến thể tích của epinephrine sớm có thể khác biệt rõ rệt giữa có và không có sốc xuất huyết (HS), nên các tác động có lợi hoặc có hại của việc kích thích epinephrine không chọn lọc (chất đồng vận alpha và beta) cũng có thể được tăng cường khi sử dụng sớm. Trong nghiên cứu này, chúng tôi nhằm phân tích hiệu quả điều trị của việc sử dụng epinephrine sớm ở trẻ em bị ngừng tim do chấn thương với và không có HS. Phương pháp Đây là một nghiên cứu hồi cứu đa trung tâm (2003–2014). Những trẻ em (dưới 19 tuổi) trải qua ngừng tim do chấn thương và được cho epinephrine để hồi sức đã được đưa vào nghiên cứu. Trẻ em được phân loại thành nhóm HS (mất máu > 30% thể tích dịch cơ thể) và nhóm không có HS. Các thông tin về nhân khẩu học, kết quả, huyết động học sau hồi sức (giờ đầu tiên) sau khi hồi phục tuần hoàn tự nhiên (ROSC) đã được phân tích và tương quan với thời gian sử dụng epinephrine (sớm < 15, giữa 15–30, muộn > 30 phút) trong nhóm HS và không có HS. Phân tích hồi quy Cox được sử dụng để điều chỉnh các yếu tố nguy cơ gây tử vong. Kết quả Tổng cộng có 509 trẻ em được đưa vào nghiên cứu. Phần lớn trong số họ (n = 348, 68.4%) có ngừng tim do chấn thương. Việc sử dụng epinephrine sớm được thực hiện ở 131 (25.7%) trẻ em. Ở cả nhóm HS và không có HS, việc sử dụng epinephrine sớm liên quan đến việc đạt được ROSC bền vững (cả hai p < 0.05) nhưng không liên quan đến khả năng sống sót hoặc kết quả thần kinh tốt (không điều chỉnh các yếu tố gây nhiễu). Tuy nhiên, việc sử dụng epinephrine sớm ở nhóm HS làm tăng cung lượng tim nhưng lại gây toan chuyển hóa và giảm sản lượng nước tiểu trong giai đoạn đầu sau hồi sức (tất cả p < 0.05). Sau khi điều chỉnh các yếu tố gây nhiễu, việc sử dụng epinephrine sớm là một yếu tố nguy cơ tử vong trong nhóm HS (HR 4.52, 95% CI 2.73–15.91). Kết luận Epinephrine sớm có liên hệ đáng kể với việc đạt được ROSC bền vững trong các trường hợp ngừng tim do chấn thương có và không có HS ở trẻ em. Đối với trẻ em có HS, việc sử dụng epinephrine sớm liên quan đến cả tác động có lợi (tăng cung lượng tim) và tác động có hại (giảm sản lượng nước tiểu và toan chuyển hóa) trong giai đoạn sau hồi sức. Quan trọng hơn, epinephrine sớm là một yếu tố nguy cơ liên quan đến tử vong trong nhóm HS.

Từ khóa


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Critical Care

Tập 23 Số 1

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