心脏骤停综合征患者进行针对性温度管理的反跳热疗组与非反跳热疗组临床结果比较

Ha Na Rhee, Jeong Yun Park
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摘要

目的:本回顾性研究旨在通过检测心脏骤停后综合征患者的体温,为干预改善临床结局提供基础数据,并明确反跳热疗(RHG)组和非反跳热疗(NRHG)组的特点。方法:本研究纳入118例在急症监护室完成目标体温管理(TTM)的患者。对数据进行频率、百分比、平均值、标准差、中位数和四分位数的分析,并使用卡方检验和Mann-Whitney u检验进行比较。结果:74例(62.7%)患者出现反跳性热疗(RH),男性居多(69.5%),平均年龄64.54±15.98岁,体重指数23.22±4.75kg/m<(超重)。高血压(50%)是最常见的合并症,其次是糖尿病和心脏病(33.1%)。自发性循环恢复后24、48和72小时,NRHG中神经元特异性烯醇化酶水平较高(p = 0.037, <i>p</i>< 0.001, <i> /i>= 0.008)。NRHG的APHCHEⅣ也较高(<i>p</i>< .001)。RH发生于TTM完成后25.49(7.28-52.96)小时,持续2(1-3)小时。降低体温的策略包括通知医生、使用退烧药和护理干预,后者最常见,占94.6%。一半的RHG受试者和77.3%的NRHG受试者属于大脑表现类别3、4和5 (<i>p</i>= .003)。结论:RH更可能是一种与CPR和TTM相关的机体机制,而不是病原感染的结果。因此,我们需要对热疗进行积极干预,并制定针对患者的护理干预方案。
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Comparison of Clinical Outcomes between Rebound Hyperthermia and Non-Rebound Hypertherma Groups in Postcardiac Arrest Syndrome Patients Undergoing Targeted Temperature Management
Purpose : This retrospective study aims to provide basic data for intervention to improve clinical outcomes and identify the characteristics of the rebound hyperthermia (RHG) and non-rebound hyperthermia (NRHG) groups by checking body temperature in patients with post-cardiac arrest syndrome.Method : The study involved 118 patients who completed target temperature management (TTM) in an acute-care unit. Data were analyzed for frequency, percentages, mean, standard deviation, median, and quartiles, and compared using the chi-squared test and Mann–Whitney U-test.Results : Rebound hyperthermia (RH) was observed in 74 (62.7%) patients, predominantly male (69.5%), with an average age of 64.54 ± 15.98, and a body mass index of 23.22 ± 4.75kg/m2 (overweight). Hypertension (50%) was the most common co-morbidity, followed by diabetes and heart disease (33.1%). Neuron-specific enolase levels were higher in the NRHG 24, 48, and 72 hours after recovery of spontaneous circulation (p = .037, p< .001, p= .008). The APHCHE Ⅳ was also higher in the NRHG (p< .001). RH occurred 25.49 (7.28–52.96) hours after TTM completion, lasting for 2 (1–3) hours. Temperature reduction strategies included notifying doctors, administering antipyretics, and nursing intervention, with the latter being the most common at 94.6%. Half of the subjects in the RHG and 77.3% in the NRHG fell into cerebral performance categories 3, 4, and 5 (p= .003).Conclusion : RH is more likely a body mechanism related to CPR and TTM than a result of pathogenic infection. Therefore, we require an active intervention for hyperthermia, and a patient-specific nursing intervention protocol.
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