The Effect of Steroid on Post-Resuscitation Outcome in Patients with Out-of-Hospital Cardiac Arrest

類固醇對到院前心跳停止病人急救後之作用

林志益(Chih-Yi Lin) ； 黃建華(Chien-Hua Huang) ； 蔡旼珊(Min-Shan Tsai) ； 張維典(Wei-Tien Chang) ； 許瓊元(Chiung-Yuan Hsu) ； 陳石池(Shyr-Chyr Chen) ； 陳文鍾(Wen-Jone Chen)

《中華民國急救加護醫學會雜誌》 21卷4期 (2010/12) Pp. 187-195

https://doi.org/10.30018/JECCM.201012.0001

摘要

目的：探討使用類固醇對於到院前心跳停止病患急救後之影響。
研究方法：自1999年1月至2007年8月，作者回顧了台大醫院非創傷性到院前心跳停止病患之資料。其中有60位病患在復甦後使用了類固醇（類固醇組），207位病患在復甦後沒有使用了類固醇（非類固醇組）。作者收集了這些病患的臨床資料、實驗室檢查以及預後並加以比較。
結果：相對於非類固醇組，類固醇組有較多的病人有慢性阻塞性肺病(25% vs. 10%, p=0.002)和非心因性的心跳停止原因(36% vs. 18%, p=0.011)。類固醇組有較高的出院率(40.0% vs. 22.7%, p=0.008)。多元邏輯式迴歸分析顯示，復甦後類固醇的使用和病患預後相關。病患因腎上線功能不足接受復甦後類固醇治療者比其他原因而使用類固醇病患有著較佳的預後。
結論：心跳停止病患於復甦後使用類固醇和較佳的出院率相關，尤其是在腎上線功能不足的病患。

關鍵字

類固醇 ； 到院前心跳停止 ； 心肺復甦 ； 自發性循環 ； 結果

並列摘要

Purpose: To examine the effect of steroid use during post-resuscitation period in cardiac arrest survivors.
Materials and Methods: From January 1999 to August 2007, non-traumatic out-of-hospital cardiac arrest (OHCA) adult survivors visiting the emergency department of the National Taiwan University Hospital were enrolled and their charts were reviewed. Sixty patients received steroid during the post-resuscitation period (steroid group), and 207 patients were without steroid therapy (non-steroid group). Clinical characteristics, laboratory examinations, and outcomes between patients in these two groups were compared.
Results: Patients in the steroid group were more likely to experience chronic obstructive pulmonary disease (COPD) (25% vs. 10%, p=0.002) and non-cardiac origin cardiac arrest (36% vs. 18%, p=0.011), compared to those in the non-steroid group. The hospital discharge rate was higher in the steroid group (40.0% vs. 22.7%, p=0.008). After controlling for potential confounders in the multiple logistic regression analysis, steroid therapy after return of spontaneous circulation (ROSC) was still associated with improved outcome. Patients received steroid therapy due to adrenal insufficiency showed a higher hospital discharge rate than patients received steroid due to other causes.
Conclusions: Steroid use in cardiac arrest patients after return of spontaneous circulation (ROSC) may be associated with an improved hospital discharge rate, especially in adrenal insufficiency patients.

並列關鍵字

steroid ； out-of-hospital cardiac arrest ； cardiopulmonary resuscitation ； return of spontaneous circulation ； outcome