ILCOR ipo nipa titun Paramedic2 Iwadii
Ka iwe-ọrọ PARAMEDIC2 lori New England Journal of Emergency Medical
Ni ọdun 2015 Igbimọ Alabaṣepọ Ilu Kariaye lori Imularada (ILCOR) ṣe atẹjade iṣeduro itọju imudojuiwọn kan fun lilo efinifirini (adrenaline) lakoko idaduro ọkan ninu awọn agbalagba
Iṣeduro daba abawọn efinifirini deede (1.0 iwon miligiramu) ni a nṣakoso si awọn alaisan agbalagba ni imuni ọkan (iṣeduro ti ko lagbara, ẹri didara-kekere) .1,2 Iṣeduro yii ṣe akiyesi anfani ti a ṣakiyesi ni awọn abajade igba kukuru [ipadabọ iyipo laipẹ (ROSC) ati gbigba wọle si ile-iwosan] ati aidaniloju nipa anfani tabi ipalara lori iwalaaye lati yosita ati abajade neurologic. Ninu atẹjade ILCOR ti o tẹle, isansa ti awọn iwadii iṣakoso ibi-iṣakoso ti iṣakoso pẹlu agbara deedee lati ṣe ayẹwo ipa ti efinifirini lori abajade igba pipẹ lẹhin ti a mu imuni ọkan ni a mọ bi aafo imoye bọtini bii iwọn lilo ti o dara julọ ati akoko ti efinifirini lakoko aisan ọkan imudani.3,4
Iwadii PARAMEDIC2 ti a gbejade laipẹ jẹ iwadii iṣakoso afọju afọju meji ti afọju ti efinifirini ti akawe si pilasibo ni awọn alaisan 8016 ni Ilu Ijọba Gẹẹsi ti ṣe itọju fun imuni-aisan ọkan ti ile-iwosan.5 Iwadi naa ni agbara fun abajade akọkọ ti iwalaaye si awọn ọjọ 30 , eyiti o jẹ 3.2% ninu efinifirini ni ẹgbẹ 2.4% ni ẹgbẹ ibibo (ipin aiṣedeede ti ko ni atunṣe 1.390; 95% CI 1.062 to 1.819; P = 0.017). Abajade elekeji pataki ti iwalaaye si awọn oṣu 3 pẹlu iṣẹ neurologic ti o dara (Modified Rankin Score 0-3) jẹ 2.1% ninu efinifirini ati 1.6% ni agbegbe ibibo 1.306; 95% CI 0.937 si 1.818, P> 0.05).
Eyi ni iṣawari iwadii iṣakoso ti iṣagbegbe akọkọ lati ṣawari anfaani iwalaaye ti o le pẹ fun efinifirini ni akoko ijadelọ ọkan ati pe o jẹ pataki pataki si aaye naa. Sibẹsibẹ, iwadi naa ko ṣe afihan iwalaaye ti o pẹ to pẹlu iṣẹ iṣan neurologic. Awọn idiwọn ti iwadi naa ni pẹlu lilo ti akoko ti a fi ni efinifirini akoko ti o wa ni deede (1.0 mg gbogbo 3-5 iṣẹju) fun gbogbo awọn alaisan ati akoko deede lati 911 lati pe si iwọn lilo oògùn akọkọ ti awọn iṣẹju 21 (IQR 16-27 iṣẹju). Gẹgẹbi a ti ṣe akiyesi loke, mejeeji iwọn lilo ti o dara julọ ati akoko isanifirini nigba idaduro iṣọn-ẹjẹ jẹ awọn ogbon imọran pataki.
Gbigbe siwaju, Ẹgbẹ Agbofinro ILCOR ALS yoo ṣe ayẹwo awọn abajade iwadi yii pataki ati pinnu bi awọn iṣeduro itọju ILCOR lọwọlọwọ fun efinifirini ni akoko CPR yẹ ki o yipada. A nireti pe awọn ilana iṣeduro igbasilẹ deedee ti a ti ni ilọsiwaju nigbagbogbo yoo jẹ ki ILCOR ṣe idahun ni akoko ti o yẹ ki o si nyara pinpin awọn iṣeduro atunṣe atunṣe.
Robert W. Neumar, MD, PhD
ILCOR Co-Igbimọ
July 18, 2018
awọn akọsilẹ:
Igbimọ Alakoso International lori Imudaniloju (ILCOR) ni a ṣe ni 1992 ati pe o pese apejọ kan fun asopọ laarin awọn ile-iṣẹ atunṣe atunṣe pataki
ni gbogbo agbaye. Iṣẹ ILCOR "lati fi awọn igbesi aye sii ni gbogbo agbaye nipasẹ isinmi" ni a firanṣẹ nipasẹ ifaramo wa si imọ-ẹri, ṣe idaniloju awọn itọju ti o dara julọ wa fun awọn ti o ni ikolu arun inu ọkan ni ayika agbaye.
Awọn ọmọ ẹgbẹ ti ILCOR ni: American Heart Association (AHA), European Resuscitation Council (ERC), Heart and Stroke Foundation of Canada (HSFC), Australian ati New Zealand Committee on Resuscitation (ANZCOR), Council Resuscitation Councils of Southern Africa (RCSA) Ilẹ Amẹrika ti Amẹrika (IAHF), Igbimọ Resuscitation ti Asia (RCA)
jo
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2. Soar J, Callaway CW, Aibiki M, et al. Apá 4: Igbesi aye igbesi aye: 2015 International Consensus lori Igbesiyanju Cashiopolmonary ati Imọ-a-Mimọ Imọ Ẹdun Kaadi pẹlu Itọju Itọju. 2015 Resuscitation; 95: e71-e120.
3. Kleinman ME, Perkins GD, Bhanji F, et al. Awọn Imọ Agbekale Sayensi Ijinlẹ ILCOR ati Awọn Iwadi Iwadi nipa Iwadii fun Imudaniloju Cosiopmonary ati Itọju Ẹdun Lilọ-pajawiri: A Gbólóhùn Ìfẹnukò. 2018 Resuscitation; 127: 132-46.
4. Kleinman ME, Perkins GD, Bhanji F, et al. Awọn Imọ Agbekale Sayensi Ijinlẹ ILCOR ati Awọn Iwadi Iwadi nipa Iwadii fun Imudaniloju Cosiopmonary ati Itọju Ẹdun Lilọ-pajawiri: A Gbólóhùn Ìfẹnukò. Aṣa 2018; 137: e802-e19.
5. Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Chip C, Regan S, Long J, Slowther A, Agbekọja H, Black JJM, Moore F, Fothergill RT, Rees N, O'Shea L, Docherty M, Gunson I, Han K, Charlton K, Finn J, Petrou S, Stallard N, Gates S, ati Lall R, fun awọn alabaṣiṣẹpọ PARAMEDIC2 * A Iwadii ti Efa fun Efinifirini ni Arun Kaadi Arun Inu Ẹjẹ. Aṣajade NENM 2018 ti NEJM www.nejm.org/doi/full/10.1056/NEJMoa1806842