Author/Editor		Kavčič, Marko; Grošelj, Urh
Title		Vpliv nadzorovane podhladitve na zdravljenje bolnikov po srčnem zastoju
Translated title		Effect of induced hypothermia on treatment of patients after cardiac arrest
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 45, št. 2
Publication year		2006
Volume		str. 115-28
Language		slo
Abstract		Cardiac arrest is the most common cause of sudden natural death. Ischemia during cardiac arrest and reperfusion damage after resuscitation are often the source prevention of permanent neurological impairment in survivors. Induced hypothernia opened the possibility of effective causal prevention of neurological damage. Induced hypothermia has been used as a standard treatment at the Center for Intesive Internal Medicine (CIIM) since year 2004. We included patients who were treated at the CIIM in the period from 1 January 2001 to 29 April 2005 following primary cardiac arrest. All enrolled patients fulfilled the criteria for treatment with induced hypothermia. The test group consisted of all patients treated after 1 January 2004, when induced hypothermia was adopted as the standard treatment method and the control group included all other patients from the observed time period. Survival, rate of neurological recovery and long-term neurological outcomes were compared, as well as the rate of complications. The final analysis included 123 patients, of whom 49 had been treated with hypothermia and 74 were control subjects. The two patient groups were comparable in terms of their basic characteristics and treatment (with the exception of controlled hypothermia). After half a year, 51% of patients who had been treated with hypothermia and 30% of those from the control group had a favorable neurological outcome (p=0.0223). In this period, 40.8% of patients treated with hypothermia and 60% of those from the control group died (p=0.0434). None of the treatment complications showed a statistically significant deviations in incidence between the two groups. 53% of patients treated with hypothermia and 79% of the control subjects were responsive in first three days (p = 0.03), while meaningful response was possible in 23% of patients treated with hypothermia and 72% of control subjects (p=0.001). (Abstract truncated at 2000 characters)
Summary		Primarni srčni zastoj je najpogostejši vzrok nenadne naravne smrti pri odraslih. Ishemija možganov med zastojem in reperfuzijska poškodba po oživljanju, sta pogosto vir trajne nevrološke prizadetosti preživelih. Nadzorovana podhladitev nezavestnih bolnikov po oživljanju odpira možnost učinkovitega vzročnega preprečevanja nevrološke okvare. Na CIIM je v rutinski uporabi od začetka leta 2004. V raziskavo smo vključili bolnike, ki so se od 1.1. 2001 do 29. 4. 2005 zdravili na CIIM po primarnem srčnem zastoju in so ustrezali kriterijem za zdravljenje z nadzorovano podhladitvijo. Testno skupino so sestavljali hlajeni bolniki, kontrolno skupino pa nehlajeni bolniki (iz obdobja pred uvedbo hlajenja). Skupini smo primerjali glede na preživetje, nevrološki izid zdravljenja, pojavnost zapletov in hitrost nevrološkega okrevanja. V raziskavo smo vključili 123 bolnikov, 49 hlajenih in 74 nehlajenih. Skupini sta primerljivi po temeljnih značilnostih bolnikov in po načinu zdravljenja (z izjemo hlajenja). Pol leta po srčnem zastoju je bilo živih 59,2 % hlajenih in 40 % nehlajenih bolnikov (p = 0,043). Nevrološki izid zdravljenja je bil pol leta po srčnem zastoju ocenjen kot uspešen pri 51 % hlajenih in 30% nehlajenih bolnikov (p=0,022). Skupini se nista statistično razlikovali glede na zaplete zdravljenja. Pri bolnikih, ki so nevrološko okrevali je bil čas do povrnitve odzivnosti krajši od tri dni pri 79 % nehlajenih in 53 % hlajenih (p=0,03). Čas do smiselnega kontakta je bil krajši od tri dni pri 72 % nehlajenih in 23 % hlajenih bolnikov (p=0,001). Nadzorovana podhladitev izboljšuje preživetje in nevrološki izid, ob tem pa ne poveča pojavnosti zapletov pri bolnikih po primarnem srčnem zastoju, zdravljenih na CIIM. Pri bolnikih, ki se jim stanje zavesti izboljša, je nevrološko okrevanje počasnejše, če so zdravljeni z nadzorovano podhladitvijo.
Descriptors		HEART ARREST HYPOTHERMIA, INDUCED RESUSCITATION BODY TEMPERATURE SURVIVAL ANALYSIS TREATMENT OUTCOME NEUROLOGIC EXAMINATION