切换至 "中华医学电子期刊资源库"
高级检索
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:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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/OL]. 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/OL]. 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
1
Peberdy MA, Kaye W, Ornato JP, et al.Cardio-pulmonary resuscitation of adults in the hospi-tal: A report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resus-citation[J]. Resuscitation, 2003, 58(3): 297-308.
2
Stiell IG, Wells GA, Field B, et al.Ontario Prehospital Advanced Life Support Study Group: Advanced cardiac life support in out-of-hospital cardiac arrest[J]. N Engl J Med, 2004, 351(7): 647-656.
3
Nolan JP, Neumar RW, Adrie C, et al.Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation；the American Heart Association Emergency Cardiovascular Care Committee；the Council on Cardiovascular Surgery and Anesthesia；the Council on Cardiopulmonary, Perioperative, and Critical Care；the Council on Clinical Cardiology；the Council on Stroke[J]. Resuscitation, 2008, 79(3): 350-379.
4
Lemiale V, Dumas F, Mongardon N, et al.Intensive care unit mortality after cardiac arrest: The relative contribution of shock and brain injury in a large cohort[J]. Intensive Care Med, 2013, 39(11): 1972-1980.
5
Sundgreen C, Larsen FS, Herzog TM, et al. Autoregulation of cerebral blood flow in patients resuscitated from cardiac arrest[J]. Stroke, 2001, 32(1): 128-132.
6
Bergman R, Braber A, Adriaanse MA, et al.Haemodynamic consequences of mild therapeutic hypothermia after cardiac arrest[J]. Eur J Anaesthesiol, 2010, 27(4): 383-387.
7
Bro-Jeppesen J, Kjaergaard J, Horsted TI, et al. The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest[J]. Resuscitation, 2009, 80(2): 171-176.
8
Bro-Jeppesen J, Kjaergaard J, soholm H, et al. Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest: Prognostic implications[J]. Resuscitation, 2014, 85(5): 664-670.
9
Trzeciak S, Jones AE, Kilgannon JH, et al. Significance of arterial hypotension after resuscitation from cardiac arrest[J]. Crit Care Med, 2009, 37(11): 2895-2903.
10
Bray JE, Bernard S, Cantwell K, et al. The association between systolic blood pressure on arrival at hospital and outcome in adults surviving from out-of-hospital cardiac arrests of presumed cardiac aetiology[J]. Resuscitation, 2014, 85(4): 509-515.
11
Beylin ME, Perman SM, Abella BS, et al.Higher mean arterial pressure with or without vasoactive agents is associated with increased survival and better neurological outcomes in comatose survivors of cardiac arrest[J]. Intensive Care Med, 2013, 39(11): 1981-1988.
12
Bouzat P, Sala N, Suys T, et al. Cerebral metabolic effects of exogenous lactate supplementation on the injured human brain[J]. Intensive Care Med, 2014, 40(3): 412-421.
[1] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[2] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[3] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[4] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[5] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[6] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[7] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[8] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[9] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[10] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[11] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[12] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[13] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号