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中华卫生应急电子杂志

中华卫生应急电子杂志 ›› 2015, Vol. 01 ›› Issue (06) : 38 -41. doi: 10.3877/cma.j.issn.2095-9133.2015.06.010

所属专题： 文献；

论著

自主循环恢复患者预后影响因素研究
韩旭东1,†(), 黄晓英1, 张素燕1, 孙维维1   
  1. 1. 226006　江苏南通，南通市第三人民医院重症医学科
  • 收稿日期:2015-12-02 出版日期:2015-12-18
  • 通信作者: 韩旭东

Factors affecting prognosis of patients with post-return of spontaneous circulation

Xudong Han1,†(), Xiaoying Huang1, Suyan Zhang1, Weiwei Sun1   

  1. 1. Intensive Care Unit, Third Hospital of Nantong City, Nantong 226006, China
  • Received:2015-12-02 Published:2015-12-18
  • Corresponding author: Xudong Han
  • About author:
    Corresponding author: Han Xudong, E-mail:
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韩旭东, 黄晓英, 张素燕, 孙维维. 自主循环恢复患者预后影响因素研究[J]. 中华卫生应急电子杂志, 2015, 01(06): 38-41.

Xudong Han, Xiaoying Huang, Suyan Zhang, Weiwei Sun. Factors affecting prognosis of patients with post-return of spontaneous circulation[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2015, 01(06): 38-41.

目的

探讨影响自主循环恢复患者预后的因素。

方法

通过对69例心跳呼吸骤停经复苏后恢复自主循环的病例进行分析，按照预后将患者分为生存组和死亡组，按照脑功能表现评分分为神经功能恢复良好组和不良组，分别对两组患者入院时的年龄、心跳停博时间等基本情况进行比较，筛选出具有统计学差异的参数，以受试者工作曲线描述各指标对神经功能恢复良好的预测价值。

结果

生存组和死亡组在年龄、心跳停搏时间、肾上腺素剂量，入院时PaO2、PaCO2、血乳酸和APACHE II评分差异均无统计学意义，生存组GCS评分和入院时平均动脉压(MAP0)、24 h内最低平均动脉压(MAPlow)、24 h乳酸清除率(DLC)均显著高于死亡组，复苏所用时间，最大去甲肾上腺用量明显低于死亡组。神经功能恢复良好组GCS评分、血糖、MAP和DLC均显著高于预后不良组，复苏中所用肾上腺素用量和去甲肾上腺剂量均低于预后不良组。MAP0和MAPlow、DLC、GCS的ROC曲线下面积分别为0.739、0.794、0.771和0.804。

结论

自主循环功能恢复后血压水平、GCS评分以及24 h乳酸清除率可有效预测心肺复苏患者预后。

关键词: 心肺复苏, 自主循环恢复, 预后
Objective

To explore the factors that could affect the prognosis of patients with sudden death after post-return of spontaneous circulation (ROSC).

Methods

A total of 69 cases of return of spontaneous circulation were reviewed, which were divided based on outcome into survival group and death group. They were also divided into good and poor groups according to the neurological status at hospital discharge. The receiver operating characteristic(ROC) curve of GCS and mean arterial blood pressure (MAP) , and 24 hours decline in lactate concentration(DLC) were compared in the two group to predict the prognosis, and the area under ROC were calculated.

Results

There was no significant difference in the age of years, the time to return of spontaneous circulation, the dosage of adrenalin, PaO2, PaCO2, arterial lactic acid and APACHE II scores between the survival group and death group. The GCS scores and mean arterial blood pressure at arrival and the DLC in the survival group were higher than that of death group. The time spent on resuscitation, the largest dosage of norepinephrine in the survival group were lower than that of death group. Seventeen patients had good neurological status at discharge, while the other 56 were poor according to the cerebral performance Category. The GCS scores and blood glucose, mean arterial blood pressure in the good group were higher than that of poor group. The dosage of adrenalin and norepinephrine in the good group was also lower than that of poor group. The area under receiver operating characteristic (ROC) curve of MAP0, MAPlow, DLC and GCS were 0.739, 0.794, 0.771 and 0.804, respectively.

Conclusion

The mean arterial blood pressure, the GCS score and DLC may predict the prognosis of patients with sudden death after post-return of spontaneous circulation.

Key words: Cardiopulmonary resuscitation, Return of spontaneous circulation, Prognosis
表1 69例自主循环恢复患者病例特征生存组与死亡组比较
组别 年龄(岁) 男性(总和) 心跳骤停原因
急性冠脉综合症 恶性心律失常 窒息 中毒 肺栓塞 高钾血症 原因不明 场所(院内)
生存组 65.6±17.1 26(35) 9 7 9 1 2 2 4 26
死亡组 66.4±17.0 19(34) 10 8 12 1 1 1 5 70
t/χ2值 0.388 2.57 — — — — — — — 1.86
P值 0.83 >0.05 — — — — — — — >0.05
表2 生存组和死亡组GCS评分，MAP等指标比较(±s)
项目 生存组 死亡组 P值
年龄(岁) 65.6±17.1 67.2±17.3 >0.05
GCS评分 6.91±4.29 4.35±1.86 <0.05
停搏时间(min) 10.85±13.18 13.53±16.33 >0.05
复苏时间(min) 13.94±8.42 22.97±19.10 <0.05
肾上腺素用量(mg) 2.69±3.01 2.56±2.77 >0.05
去甲肾上腺素剂量 13.50±11.30 22.66±20.14 <0.05
MAP0(mmHg) 78.68±11.02 71.55±8.58 <0.05
MAPlow(mmHg) 66.40±12.59 57.88±9.24 <0.05
WBC(×109) 16.19±8.27 21.47±12.85 >0.05
Plt(×109) 151.51±68.07 153.78±94.45 >0.05
pH 7.28±0.16 7.21±0.22 >0.05
PaO2(mmHg) 138.23±99.95 108.75±74.80 >0.05
PaCO2(mmHg) 46.22±18.37 55.17±23.31 >0.05
Lac(mmol/L) 8.78±5.34 6.86±3.75 >0.05
DLC(%) 41.32±18.45 35.14±17.32 <0.05
Glu(mmol/L) 13.78±6.40 12.30±5.25 >0.05
APACHEⅡ 35.20±8.45 36.76±7.23 >0.05
表3 神经功能恢复良好组与不良组各指标比较(±s)
项目 神经功能恢复良好组 神经功能不良或死亡组 P值
年龄(岁) 60.2±21.0 67.77±15.26 >0.05
GCS评分 8.47±4.11 4.64±2.74 <0.01
停搏时间(min) 9.41±10.58 13.40±16.79 >0.05
复苏时间(min) 15.12±12.01 22.73±19.08 >0.05
肾上腺素用量(mg) 1.71±1.89 3.16±3.28 <0.05
去甲肾上腺素剂量 7.00±5.86 13.62±7.76 <0.01
MAP0(mmHg) 82.58±10.76 72.93±9.64 <0.01
MAPlow(mmHg) 71.70±10.12 58.80±10.89 <0.01
WBC(×109) 15.10±7.77 19.49±11.60 >0.05
Plt(×109) 161.64±77.54 148.03±81.64 >0.05
PH 7.30±0.16 7.23±0.20 >0.05
PaO2(mmHg) 110.58±36.52 125.14±93.76 >0.05
PaCO2(mmHg) 48.98±20.88 51.45±21.73 >0.05
Lac(mmol/L) 7.90±4.38 8.30±4.94 >0.05
DLC(%) 49.97±15.08 30.41±21.29 <0.01
Glu(mmol/L) 15.70±6.80 12.16±5.28 <0.05
APACHEⅡ 34.11±8.43 36.23±8.00 >0.05
图1 MAP0和MAPlow、GCS、DLC等预测预后的ROC曲线
表4 GCS、MAP等预测患者预后的ROC曲线下面积比较
检验曲线变量 曲线面积 标准误a 渐进Sigb 渐近95%置信区间
下限 上限
GCS 0.802 0.063 0.000 0.678 0.926
DLC 0.771 0.062 0.001 0.649 0.892
APACHEⅡ 0.418 0.079 0.310 0.264 0.573
Glu 0.648 0.081 0.067 0.489 0.806
MAPlow 0.794 0.053 0.000 0.689 0.898
MAP0 0.739 0.065 0.003 0.611 0.867
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