芝加哥 – 據(jù)7月17日發(fā)表在《美國醫(yī)學會雜志》上的一則研究披露,，在經(jīng)歷過住院時需要使用血管加壓藥物（即可升高血壓的藥物）的心臟驟停的患者中，在心肺復蘇時使用一種組合療法可改善患者的存活率并使其出院時具有良好的神經(jīng)功能狀態(tài)。
根據(jù)文章的背景資料：“心臟驟停后的神經(jīng)功能轉(zhuǎn)歸一直是數(shù)個隨機性臨床試驗（RCTs）的主要終點,。具有良好的神經(jīng)功能性的存活率與整體存活率不同,。在心臟驟停的存活者中,，嚴重腦殘疾或植物人狀態(tài)的發(fā)生率在25%至50%的范圍內(nèi),。在從前的一個單一中心的RCT中，在進行心肺復蘇（CPR）過程中組合使用血管加壓素-腎上腺素,，及在進行心肺復蘇（CPR）過程中和之后使用皮質(zhì)類固醇補充劑,，與在進行心肺復蘇（CPR）過程中僅使用腎上腺素且不使用類固醇相比，可改善患者在出院時的整體存活率,。然而,，這一初步的研究無法可靠地評估血管加壓素-類固醇-腎上腺素（VES）對出院時具有良好神經(jīng)功能性存活的功效。”
希臘雅典市雅典大學醫(yī)學院的Spyros D. Mentzelopoulos, M.D., Ph.D.及其同事開展了一項研究,，旨在確定在進行心肺復蘇（CPR）過程中組合使用血管加壓素-腎上腺素,、及在進行心肺復蘇（CPR）過程中和之后使用皮質(zhì)類固醇補充劑是否會改善患者在出院時,、在腦功能分類（CPC）尺度中具有良好神經(jīng)功能評分的存活率。這一隨機化的,、有安慰劑作為對照的試驗是在2008年9月至2010年10月在希臘的3個三級醫(yī)療中心內(nèi)進行的,；該試驗包括了根據(jù)復蘇指南需要用腎上腺素的268名心臟驟停的病人。
在隨機化之后,，患者在頭5個CPR周期時或是接受加壓素加腎上腺素（VSE組,，n=130），或是接受鹽水安慰劑加腎上腺素（對照組,，n=138）,，并在之后按照需要給予了額外的腎上腺素,。在隨機化后的第一個CPR周期中,，VSE組的患者會接受甲基強的松龍；對照組患者會接受鹽水安慰劑,。復蘇后的休克會用應激劑量的氫化可的松（VSE組,，n=76）進行治療或接受鹽水安慰劑（對照組，n=73）,。該研究的主要轉(zhuǎn)歸為回復到自主循環(huán)（ROSC）達20分鐘或以上并在出院時具有CPC評分1或2的存活,。
VSE組的病人與對照組的病人相比有較高的20分鐘或以上的ROSC的概率（109/130 [83.9%] vs. 91/138 [65.9%]）。與對照組的病人相比,，VSE組的病人在隨訪時具有較低的不良轉(zhuǎn)歸風險,，且他們更可能在出院時活著并具有良好的神經(jīng)功能恢復（18/130 [13.9%] vs. 7/138 [5.1%]）。
在存活4小時或以上的人中,，復蘇后休克的VSE患者(n = 76) vs.相應的對照組患者(n = 73)在隨訪時具有較低的不良轉(zhuǎn)歸風險,，且他們更可能在出院時存活并具有良好的神經(jīng)功能恢復（16/76 [21.1%] vs. 6/73 [8.2%]）。
文章的作者寫道：“在這一對需要使用血管加壓藥物的心臟驟?；颊叩难芯恐?，與腎上腺素和鹽水安慰劑相比，組合使用血管加壓素和腎上腺素連同在CPR時使用甲基強的松龍及在復蘇后的休克中使用氫化可的松可改善患者的存活率并使其在出院時具有良好的神經(jīng)功能狀態(tài),。這些結(jié)果與對住院時發(fā)生的需要用血管加壓藥物的心臟驟停進行CPR時,，VSE組合vs.僅用腎上腺素可增加治療功效是一致的。”（生物谷Bioon.com）
生物谷推薦英文摘要：
Jama doi:10.1001/jama.2013.7832
Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest:
Spyros D. Mentzelopoulos, MD, PhD; Sotirios Malachias, MD; Christos Chamos, MD; Demetrios Konstantopoulos, MA; Theodora Ntaidou, MD; Androula Papastylianou, MD, PhD; Iosifinia Kolliantzaki, MD; Maria Theodoridi, MD; Helen Ischaki, MD, PhD; Dimosthemis Makris, MD, PhD; Epaminondas Zakynthinos, MD, PhD; Elias Zintzaras, MD, PhD; Sotirios Sourlas, MD; Stavros Aloizos, MD; Spyros G. Zakynthinos, MD, PhD
Importance Among patients with cardiac arrest, preliminary data have shown improved return of spontaneous circulation and survival to hospital discharge with the vasopressin-steroids-epinephrine (VSE) combination.
Objective To determine whether combined vasopressin-epinephrine during cardiopulmonary resuscitation (CPR) and corticosteroid supplementation during and after CPR improve survival to hospital discharge with a Cerebral Performance Category (CPC) score of 1 or 2 in vasopressor-requiring, in-hospital cardiac arrest.
Design, Setting, and Participants Randomized, double-blind, placebo-controlled, parallel-group trial performed from September 1, 2008, to October 1, 2010, in 3 Greek tertiary care centers (2400 beds) with 268 consecutive patients with cardiac arrest requiring epinephrine according to resuscitation guidelines (from 364 patients assessed for eligibility).
Interventions Patients received either vasopressin (20 IU/CPR cycle) plus epinephrine (1 mg/CPR cycle; cycle duration approximately 3 minutes) (VSE group, n=130) or saline placebo plus epinephrine (1 mg/CPR cycle; cycle duration approximately 3 minutes) (control group, n=138) for the first 5 CPR cycles after randomization, followed by additional epinephrine if needed. During the first CPR cycle after randomization, patients in the VSE group received methylprednisolone (40 mg) and patients in the control group received saline placebo. Shock after resuscitation was treated with stress-dose hydrocortisone (300 mg daily for 7 days maximum and gradual taper) (VSE group, n=76) or saline placebo (control group, n=73).
Main Outcomes and Measures Return of spontaneous circulation (ROSC) for 20 minutes or longer and survival to hospital discharge with a CPC score of 1 or 2.
Results Follow-up was completed in all resuscitated patients. Patients in the VSE group vs patients in the control group had higher probability for ROSC of 20 minutes or longer (109/130 [83.9%] vs 91/138 [65.9%]; odds ratio [OR], 2.98; 95% CI, 1.39-6.40; P=.005) and survival to hospital discharge with CPC score of 1 or 2 (18/130 [13.9%] vs 7/138 [5.1%]; OR, 3.28; 95% CI, 1.17-9.20; P=.02). Patients in the VSE group with postresuscitation shock vs corresponding patients in the control group had higher probability for survival to hospital discharge with CPC scores of 1 or 2 (16/76 [21.1%] vs 6/73 [8.2%]; OR, 3.74; 95% CI, 1.20-11.62; P=.02), improved hemodynamics and central venous oxygen saturation, and less organ dysfunction. Adverse event rates were similar in the 2 groups.
Conclusion and Relevance Among patients with cardiac arrest requiring vasopressors, combined vasopressin-epinephrine and methylprednisolone during CPR and stress-dose hydrocortisone in postresuscitation shock, compared with epinephrine/saline placebo, resulted in improved survival to hospital discharge with favorable neurological status.
