Analysis of relevant factors influencing the 30-day survival rate of patients with cardiac arrest and cardiopulmonary resuscitation: research based on 8-year data of a class III hospital / 中华危重病急救医学

OBJECTIVE@#To investigate the survival of patients with cardiac arrest and cardiopulmonary resuscitation (CA-CPR), and to analyze the factors influencing survival at 30 days after restoration of spontaneous circulation (ROSC).@*METHODS@#A retrospective cohort study was conducted. Clinical data of 538 patients with CA-CPR admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2013 to September 2020 were enrolled. The gender, age, underlying disease, cause of CA, type of CA, initial rhythm, presence or absence of endotracheal intubation, defibrillation, use of epinephrine, and 30-day survival rate of patients were collected. The etiology of CA and 30-day survival rate among patients with different ages were compared, as well as the clinical data between patients who survived and died at 30 days after ROSC were also compared. Multivariate Logistic regression was used to analyze the relevant factors affecting the 30-day survival rate of patients.@*RESULTS@#Among 538 patients with CA-CPR, 67 patients with incomplete information were excluded, and 471 patients were enrolled. Among 471 patients, 299 were males and 172 were females. Aged from 0 to 96 years old, 23 patients (4.9%) were < 18 years old, 205 patients (43.5%) were 18 to 64 years old, and 243 patients (51.6%) were ≥ 65 years old. 302 cases (64.1%) achieved ROSC, and 46 patients (9.8%) survived for more than 30 days. The 30-day survival rate of patients aged < 18 years old, 18-64 years old and ≥ 65 years old was 8.7% (2/23), 12.7% (26/205) and 7.4% (18/243), respectively. The main causes of CA in patients younger than 18 years were severe pneumonia (13.1%, 3/23), respiratory failure (13.1%, 3/23), and trauma (13.1%, 3/23). The main causes were acute myocardial infarction (AMI; 24.9%, 51/205), respiratory failure (9.8%, 20/205), and hypoxic brain injury (9.8%, 20/205) in patients aged 18-64 years old, and AMI (24.3%, 59/243) and respiratory failure (13.6%, 33/243) in patients aged ≥ 65 years old. Univariate analysis results revealed that the 30-day survival rate of patients with CA-CPR may be related to the the cause of CA was AMI, initial rhythm was ventricular tachycardia/ventricular fibrillation, endotracheal intubation and epinephrine. Multivariate Logistic regression analysis results showed that CA was caused by AMI [odds ratio (OR) = 0.395, 95% confidence interval (95%CI) was 0.194-0.808, P = 0.011] and endotracheal intubation (OR = 0.423, 95%CI was 0.204-0.877, P = 0.021) was a protective factor for 30 days of survival after ROSC in patients with CA-CPR.@*CONCLUSIONS@#The 30-day survival rate of CA-CPR patients was 9.8%. The 30-day survival rate of CA-CPR patients with AMI after ROSC is higher than that of patients with other CA causes, and early endotracheal intubation can improve the prognosis of patients.

Effects on Various Indicators of Exenatide in Young and Middle-aged Patients with Type 2 Diabetes and Non-alcoholic Fatty Liver Disease / 中国药师

Objective: To investigate the effect of exenatide on body weight, blood glucose, blood lipids, insulin resistance and the degree of fatty liver in young and middle-aged patients with type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). Meth-ods: Totally 70 young and middle-aged patients with poorly controlled type 2 diabetes and NAFLD were chosen and randomly divided into observation group and the control group with 35 cases in each group. The patients were treated with exenatide or isophane prota-mine biosynthetic human insulin injection for 3 months on the basis of original oral hypoglycemic drugs. The body weight, BMI, waist circumference, HOMA-IR, plasma glucose (FPG), 2 hour postprandial blood glucose (2hPG), glycated hemoglobin (HbAlc), blood lipids, liver function indices (ALT, AST and GGT), and the severity of fatty liver were compared before and after the treatment. Re-sults: After the 3-month treatment, there was no significant difference in glycemic control between observation group and the control group. After treatment, the body weight, BMI, waist circumference, HOMA-IR, TG, ALT, AST and GGT in observation were signifi-cantly decreased than those before the treatment(P<0. 05), and were superion to those in control group(P<0. 05). While in the control group, all the above indices were not significantly changed before and after the treatment (P>0. 05). The total efficiency for treating NAFLD in observation group was significantly higher than that in the control group (P<0. 05). Conclusion: Besides reducing blood glucose effectively, exenatide can also obviously reduce body weight and TG level, improve insulin resistance, decrease liver en-zymes, and significantly ameliorate the degree of fatty liver. The results suggested that exenatide might be a new therapeutic option for young and middle-aged patients with type 2 diabetes and NAFLD.

Effects of Exenatide on Body Weight, Blood Glucose, Blood Lipids and Proteinuria in Obese and Overweight Young and Middle-aged Patients with Type 2 Diabetes / 中国药师

Objective: To investigate the effects of exenatide on body weight, blood glucose, blood lipids and proteinuria in obese and overweight young and middle-aged patients with type 2 diabetes to provide reference for better controlling the macro-vascular and micro-vascular complications in the patients.Methods: Totally 60 obese and overweight young and middle-aged patients with poorly controlled type 2 diabetes were chosen and randomly divided into exenatide group and novolin N group with 30 ones in each.The patients maintained the previous oral hypoglycemic drugs, and exenatide group was treated with exenatide, Novolin N group was treated with protamine biosynthetie human insulin(NovolinN), and the treatment course was 3 months.The body weight, BMI, fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), glycated hemoglobin (HbA1C), fasting C-peptide (FCP), 2-hour postprandial C-peptide (2hCP), blood lipids, plasma homocysteine (HCY) and urine microalbumin (UMA) were compared before and after the treatment.Results: After 3 month treatment,the FPG,zhpG and HbAlc were significantly decreased both in exenatide group and NwoCinN group(P0.05).In exenatide group, the levels of FCP and 2hCP were higher than those before the treatment (P0.05).Conclusion: Exenatide can effectively control blood glucose, improve β-cell function, reduce body weight, lower blood lipids and decrease urine protein.