Effects of medium-dose dopamine combined with epinephrine on the rescue success rate and spontaneous circulation recovery time and cerebral oxygen metabolism indexes in patients with cardiac arrest
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摘要: 目的 研究中等剂量多巴胺联合肾上腺素对心跳骤停患者抢救成功率、自主循环恢复时间及脑氧代谢指标的影响。方法 前瞻性选取2019年1月-2020年1月在我院发生心跳骤停的患者80例，其中40例采用小剂量多巴胺联合肾上腺素治疗(对照组)，40例采用中等剂量多巴胺联合肾上腺素治疗(研究组)。比较两组患者抢救成功率、自主循环恢复时间、颈内静脉球血氧饱和度(SjvO2)、脑氧代谢率(CMRO2)、脑血流量(CBF)、脑动脉-静脉氧含量差(a-vDO2)。结果 研究组自主循环恢复时间较对照组低，且差异有统计学意义(P < 0.05)；研究组患者复苏后3 d的SjvO2较对照组低，CMRO2、CBF、a-vDO2较对照组高，差异有统计学意义(P < 0.05)；研究组复苏后4、12、24 h平均动脉压较对照组高(P < 0.05)；研究组24 h存活率、出院存活率较对照组高，且差异有统计学意义(P < 0.05)。结论 使用中等剂量多巴胺联合肾上腺素救治心跳骤停患者，可以明显提高患者的抢救成功率，缩短自主循环恢复时间，改善脑氧代谢相关指标，从而促进患者脑功能恢复，改善预后。Abstract: Objective To study the effect of medium-dose dopamine combined with adrenaline on the rescue success rate, autonomous circulation recovery time and brain oxygen metabolism index in cardiac arrest patients.Methods Prospectively select 80 patients with cardiac arrest in our hospital from January 2019 to January 2020, of which 40 cases were treated with low-dose dopamine combined with epinephrine (control group), and 40 cases were treated with medium-dose dopamine combined with epinephrine (study group).Eighty patients suffered cardiac arrest from January 2019 to January 2020, were chose to conduct prospective studies, randomly divided into control group(40) and study group(40) according to the treatment protocol. The control group was treated with small-dose dopamine combined with epinephrine, and the study group was treated with patients with cardiac arrest. The success rate of rescue, the time of independent circulation recovery, intranjugular venous blood oxygen saturation(SjvO2), cerebral oxygen metabolism rate(CMRO2), cerebral blood flow(CBF), and poor cerebral artery-venous oxygen content(a-vDO2) were compared between the two groups.Results The recovery time of autonomic circulation in the study group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Three days after resuscitation, SjvO2 in the study group was lower than that in the control group, and CMRO2, CBF, and a-vDO2 were higher than those in the control group, the difference was statistically significant(P < 0.05).The average arterial pressure of the study group at 4, 12 and 24 hours after resuscitation was higher than that of the control group (P < 0.05). The 24h survival rate and discharge survival rate of the study group were higher than those of the control group, and the difference was statistically significant (P < 0.05).Conclusion The use of medium dose dopamine with adrenaline to treat patients with cardiac arrest can significantly improve the success rate, shorten autonomous circulation recovery time, improve brain oxygen metabolism, thus promote the recovery of brain function and benefit prognosis.
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表 1 两组一般资料比较
例，X±S 组别 例数 性别 平均年龄/岁 平均体重/kg 心脏停搏发生到发现时间/min 发病原因 男 女 心肌梗死 肺炎 脑卒中 药物中毒 对照组 40 22 18 52.95±7.88 65.05±5.28 2.35±0.68 10 11 4 15 研究组 40 23 17 53.09±7.21 64.98±5.34 2.46±0.71 8 13 10 9 t/χ2 0.051 0.083 0.059 0.708 4.460 P 0.822 0.934 0.953 0.481 0.216 
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表 2 两组患者发病后不同时间脑氧代谢指标比较
X±S 组别 SjvO2 /% CMRO2 /% CBF/(mL·min-1) a-vDO2 /% 24 h 3 d 24 h 3 d 24 h 3 d 24 h 3 d 研究组 99.17±3.26 67.45±10.781) 89.95±5.03 241.17±137.311) 4.11±0.32 6.74±0.451) 15.01±0.22 44.64±21.581) 对照组 98.81±3.02 76.39±13.48 90.28±6.07 163.25±66.77 4.21±0.29 5.31±0.39 14.98±0.03 28.21±16.16 t 0.512 3.276 0.265 3.228 1.465 15.188 0.855 3.854 P 0.610 0.002 0.792 0.002 0.147 < 0.001 0.395 < 0.001 与同组复苏后24 h相比，1)P < 0.05。
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表 3 两组患者复苏后平均动脉压情况比较
mmHg 组别 复苏后4 h 复苏后12 h 复苏后24 h 研究组 69.21±8.36 77.65±10.47 86.31±27.69 对照组 60.98±8.21 64.74±10.38 66.85±22.74 t 4.442 5.538 3.435 P < 0.001 < 0.001 0.001 注：1 mmHg=0.133 kPa。
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表 4 两组24h存活率、复苏成功率、自主循环恢复率、出院存活率比较
例(%) 组别 例数 自主循环恢复 复苏成功 24 h存活 出院存活 研究组 40 37(92.5) 36(90.0) 35(87.5) 14(35.0) 对照组 40 31(77.5) 30(75.0) 26(65.0) 5(12.5) χ2 3.529 3.117 5.591 5.591 P 0.060 0.077 0.018 0.018
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