Цитата:
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Сообщение от Dr. Makhotin
У меня вызывает! Приведу, пока, одно возражение: сдвиг кривой диссоциации оксигемоглобина - повышение сродства кислорода к Hb и как следствие тканевая гипоксия (на фоне достаточного парциального давления кислорода в артериальной крови).
А у Вас какие мотивы, что это Вам даст?
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Вот мои аргументы. Ноя правда хотел говоритьне о аргументах, о тактике.
N Engl J Med, Vol. 346, No. 8
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February 21, 2002
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INDUCED HYPOTHERMIA AFTER OUT-OF-HOSPITAL CARDIAC ARREST
TREATMENT OF COMATOSE SURVIVORS OF OUT-OF-HOSPITAL CARDIAC
ARREST WITH INDUCED HYPOTHERMIA
ABSTRACT
Background
Cardiac arrest outside the hospital is
common and has a poor outcome. Studies in laboratory
animals suggest that hypothermia induced shortly
after the restoration of spontaneous circulation may
improve neurologic outcome, but there have been
no conclusive studies in humans. In a randomized,
controlled trial, we compared the effects of moderate
hypothermia and normothermia in patients who
remained unconscious after resuscitation from outof-
hospital cardiac arrest.
Methods
The study subjects were 77 patients who
were randomly assigned to treatment with hypothermia
(with the core body temperature reduced to 33°C
within 2 hours after the return of spontaneous circulation
and maintained at that temperature for 12 hours)
or normothermia. The primary outcome measure was
survival to hospital discharge with sufficiently good
neurologic function to be discharged to home or to
a rehabilitation facility.
Results
The demographic characteristics of the
patients were similar in the hypothermia and normothermia
groups. Twenty-one of the 43 patients treated
with hypothermia (49 percent) survived and had
a good outcome — that is, they were discharged
home or to a rehabilitation facility — as compared
with 9 of the 34 treated with normothermia (26 percent,
P=0.046). After adjustment for base-line differences
in age and time from collapse to the return of
spontaneous circulation, the odds ratio for a good
outcome with hypothermia as compared with normothermia
was 5.25 (95 percent confidence interval,
1.47 to 18.76; P=0.011). Hypothermia was associated
with a lower cardiac index, higher systemic vascular
resistance, and hyperglycemia. There was no difference
in the frequency of adverse events.