頑固型心室顫動的復甦：使用葉克膜心肺復甦術與傳統心肺復甦術之比較

Resuscitation for refractory ventricular fibrillation: extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation

邱俊文(Chun-Wen Chiu)

指導教授 ： 陳百薰

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2017年)

摘要

中文摘要
研究目的
頑固型心室顫動是一種致命的心律，且對於傳統心肺復甦術（C-CPR）效果不彰。雖然之前的報告建議使用葉克膜心肺復甦術（E-CPR）來改善長時間心跳停止的成效，但是葉克膜心肺復甦術對於頑固型心室顫動的治療成效並不明瞭。本研究主要探討傳統心肺復甦術與葉克膜心肺復甦術對於頑固型心室顫動的治療效果。
研究方法
本研究以台灣中部某醫學中心的病例做回朔性研究，收集2011年九月到2013年九月的案例。共回朔209例在急診發生心室顫動個案，其中六十例發生頑固型心室顫動並急救超過十分鐘。其中比較傳統心肺復甦術（C-CPR, N=40）和葉克膜心肺復甦術（E-CPR, N=20）的臨床成效如壓胸時間，電擊次數和給藥劑量等等。
研究結果
研究整體病患的存活率為35%，其中有良好神經學表現的出院病患者18.3%。平均心肺復甦術時間，葉克膜心肺復甦術組高於傳統心肺復甦術組(69.9 ± 49.6 min vs 34.3 ± 17.7 min, p = 0.0001)。病人接受葉克膜心肺復甦術有較高的比例恢復自發性心律(95.0% vs 47.5%, p = 0.0009)，和較好的出院神經學表現(40.0% vs 7.5%, p = 0.0067)。而且葉克膜心肺復甦術有較高的存活率(50% vs 27.5%, p = 0.1512)和一年後存活率 (50% vs 20%, p = 0. 0998) 。
研究結論
臨床上在急診處理頑固型心室顫動仍然是高度挑戰的情境，在本研究中，存活率為35%。臨床使用葉克膜心肺復甦術相較於傳統心肺復甦術有較高的存活率和較好神經學表現。

關鍵字

心室顫動 ； 心肺復甦術 ； 葉克膜心肺復甦術

並列摘要

AIM
Refractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (C-CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution.
METHOD
This is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10 minutes. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n = 40) or CPR plus extracorporeal CPR (E-CPR, n = 20) were compared.
RESULTS
The overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90 ± 49.6 min vs 34.3 ± 17.7 min, p = 0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p = 0.0009), and good neurological function at discharge (40.0% vs 7.5%, p = 0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p = 0.1512) at discharge and (50% vs 20%, p = 0. 0998) at 1 year after discharge.
CONCLUSIONS
The resuscitation of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR.

並列關鍵字

ventricular fibrillation ； cardiopulmonary resuscitation ； extracorporeal CPR

參考文獻

REFERENCE

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