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中华卫生应急电子杂志 ›› 2018, Vol. 04 ›› Issue (01) : 21 -25. doi: 10.3877/cma.j.issn.2095-9133.2018.01.004

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论著

TCD联合APACHEⅡ评分在腹部心肺复苏脑功能预后中的价值
岑颖欣1, 张思森2,(), 汪宏伟1, 刘婷1, 赵龙现3, 张存庆4, 李静4, 王立祥5   
  1. 1. 510280 广东广州,南方医科大学第二临床医学院
    2. 510280 广东广州,南方医科大学第二临床医学院;450003 河南郑州,郑州人民医院
    3. 472000 河南三门峡,三门峡市中心医院
    4. 100038 北京,北京德美瑞医疗设备有限公司
    5. 100039 北京,中国武警总医院急救医学中心
  • 收稿日期:2018-01-28 出版日期:2018-02-18
  • 通信作者: 张思森
  • 基金资助:
    河南省科技惠民重点支持项目(152207310007); 河南省(郑州)科技领军人才重点支持项目(131PLJRC682); 国家新型实用专利号(ZL 200920164343.6,ZL 200920160376.3,ZL 2014 3 0044027.1)

Clinical study of TCD combined with APACHE II scores in the prognosis of neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation

Yingxin Cen1, Sisen Zhang2,(), Hongwei Wang1, Ting Liu1, Longxian Zhao3, Cunqing Zhang4, Jing Li4, Lixiang Wang5   

  1. 1. Department of Emergency, The Second School of Clinical Medicine, Southern Medical University, Affiliated Zhengzhou People’s Hospital, Zhengzhou 450003, China
    2. Department of Emergency, The Second School of Clinical Medicine, Southern Medical University, Affiliated Zhengzhou People’s Hospital, Zhengzhou 450003, China; Zhengzhou People’s Hospital Emergency Medical Center, Zhengzhou 450003, China
    3. Sanmenxia city central hospital Emergency Medical Center, Sanmenxia 450003, China
    4. Beijing Germari Medical Equipment Co., Ltd, Beijing 100038, China
    5. Emergency Medical Center, General Hospital of Chinese Armed Police Forces, Beijing 100039, China
  • Received:2018-01-28 Published:2018-02-18
  • Corresponding author: Sisen Zhang
  • About author:
    Corresponding author: Zhang Sisen, Email:
引用本文:

岑颖欣, 张思森, 汪宏伟, 刘婷, 赵龙现, 张存庆, 李静, 王立祥. TCD联合APACHEⅡ评分在腹部心肺复苏脑功能预后中的价值[J]. 中华卫生应急电子杂志, 2018, 04(01): 21-25.

Yingxin Cen, Sisen Zhang, Hongwei Wang, Ting Liu, Longxian Zhao, Cunqing Zhang, Jing Li, Lixiang Wang. Clinical study of TCD combined with APACHE II scores in the prognosis of neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2018, 04(01): 21-25.

目的

探讨早期经颅多普勒超声(TCD)和APACHEⅡ评分对腹部心肺复苏术后患者脑功能复苏预后的评估价值。

方法

选取郑州人民医院医疗集团及三门峡中心医院所属急救站急诊经腹部心肺复苏救治成功后66例心搏骤停(CA)患者为研究对象进行回顾性病例对照研究,其中男性34例,女性32例;年龄19~80岁,平均(50.91±14.50)岁。患者根据复苏后3个月内的格拉斯哥-匹兹堡脑功能分级(CPC)分为预后良好组(CPC 1~CPC 2,29例)和预后不良组(CPC 3~CPC 5,37例)。比较两组患者腹部心肺复苏成功后24h经TCD测得的脑血流和APACHEⅡ评分结果,分析两指标的相关性并分别绘制对CA患者脑复苏预后预测的受试者工作特征(ROC)曲线,计算ROC曲线下面积以评估该指标对CA患者脑复苏预后预测的准确性。

结果

预后良好组CA患者腹部提压心肺复苏后24 h的脑血流明显高于预后不良组[(6.23±1.88) vs (4.88±1.15),P<0.05],APACHEⅡ评分明显低于预后不良组[(15.31±5.37)分vs (25.05±7.94)分,P<0.05],两者呈负相关性。脑血流对脑功能预后预测的曲线下面积为0.722,APACHEⅡ评分曲线下面积为0.844。

结论

心肺复苏早期脑血流越大、APACHEⅡ评分越低,患者脑功能预后越好。两者对腹部提压心肺复苏术后CA患者的脑功能预后评价具有指导意义。

Objective

The aim of the study was to demonstrate that TCD and APACHE II scores can be used as predictors of the neurologic outcome after abdominal cardiopulmonary resuscitation.

Methods

A retrospective study was performed in a total of 66 cardiac arrest patients with abdominal cardiopulmonary resuscitation in Zhengzhou People’s Hospital and Sanmenxia center hospital were selected. There were 34 males and 32 females, whose age ranged from 19 years old to 80 years old with the mean age of 50.91±14.50 years. According to the Glasgow-Pittsburgh cerebral performance categories, the patients were divided into favorable prognosis group with the CPC1~2(n=29)and unfavorable prognosis group with the CPC3~5 (n=37). Two groups of patients’CBF by TCD and APACHEⅡ scores were compared in 24 hours after successful abdominal cardiopulmonary resuscitation. The date was analyzed and receiver operating characteristic curves were made.

Results

CBF of favorable prognosis group was higher than that of unfavorable prognosis group[(6.23±1.88)vs(4.88±1.15), P<0.05], and APACHEⅡ scores was lower than that of unfavorable prognosis group[(15.31±5.37)vs(25.05±7.94), P<0.05]. CBF had negative correlation with APACHEⅡ scores(R=-0.692, P<0.01). ROC curves for unfavorable prognosis patients revealed an area under the curve of 0.722 for CBF, and 0.844 for APACHEⅡ scores.

Conclusion

The increasing CBF and decreasing APACHEⅡ scores were observed in patients with good outcome in brain function. So CBF and APACHEⅡ scores can be used as predictors of the brain function after abdominal cardiopulmonary resuscitation.

表1 格拉斯哥-匹兹堡脑功能表现分级
表2 腹部心肺复苏后两组CA患者的脑血流和APACHEⅡ评分比较(±s)
图1 66例CA患者腹部心肺复苏后24 h的CBF和APACHEⅡ评分散点图
图2 脑血流对经腹部心肺复苏恢复自主循环的所有患者脑功能预后预测的ROC曲线
图3 APACHEⅡ评分对经腹部心肺复苏恢复自主循环的所有患者脑功能预后预测的ROC曲线
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