Postresuscitation disease after cardiac arrest: a sepsis-like syndrome?
Postresuscitation disease after cardiac arrest: a sepsis-like syndrome?
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DOI：
10.1097/01.ccx.0000126090.06275.fe
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发表时间：
2004-06-01
影响因子：
3.3
通讯作者：
Spaulding, Christian
中科院分区：
文献类型：
--
作者：
Adrie, Christophe;Laurent, Ivan;Spaulding, Christian
审查目的：尽管在心脏骤停复苏方面取得了进展，但神经功能障碍和其他器官功能障碍在自发心脏活动恢复后仍会导致相当大的死亡率和发病率。这种复苏后疾病的机制可能涉及全身缺血和再灌注综合征，引发全身炎症反应。最近的发现：复苏后疾病的特点是高水平的循环细胞因子和粘附分子，血浆内毒素的存在下，和失调的白细胞产生的细胞因子：一个配置文件中看到的严重败血症。复苏后可发生一过性心肌功能障碍，主要是由于心肌顿抑。然而，早期成功的血管成形术与心肌梗死相关心脏骤停后的良好结局独立相关。凝血异常在成功复苏后持续发生，其严重程度与死亡率相关。例如，成功复苏后，死亡者的血浆蛋白C和S活性低于存活者。低基线皮质醇水平可能与心脏骤停后致命的早期难治性休克的风险增加有关，这表明这些patients.SUMMARY肾上腺功能障碍：心脏骤停后兴奋后异常模仿严重脓毒症中观察到的免疫和凝血功能障碍。这表明，最近在严重脓毒症中成功使用的治疗方法应在心脏骤停后成功复苏的患者中进行研究。
PURPOSE OF REVIEW: Despite advances in cardiac arrest resuscitation, neurologic impairments and other organ dysfunctions cause considerable mortality and morbidity after restoration of spontaneous cardiac activity. The mechanisms underlying this postresuscitation disease probably involve a whole-body ischemia and reperfusion syndrome that triggers a systemic inflammatory response.RECENT FINDINGS: Postresuscitation disease is characterized by high levels of circulating cytokines and adhesion molecules, the presence of plasma endotoxin, and dysregulated leukocyte production of cytokines: a profile similar to that seen in severe sepsis. Transient myocardial dysfunction can occur after resuscitation, mainly as a result of myocardial stunning. However, early successful angioplasty is independently associated with better outcomes after cardiac arrest associated with myocardial infarction. Coagulation abnormalities occur consistently after successful resuscitation, and their severity is associated with mortality. For example, plasma protein C and S activities after successful resuscitation are lower in nonsurvivors than in survivors. Low baseline cortisol levels may be associated with an increased risk of fatal early refractory shock after cardiac arrest, suggesting adrenal dysfunction in these patients.SUMMARY: Postresuscitation abnormalities after cardiac arrest mimic the immunologic and coagulation disorders observed in severe sepsis. This suggests that therapeutic approaches used recently with success in severe sepsis should be investigated in patients successfully resuscitated after cardiac arrest.