观察早期冰盐水诱导亚低温对心肺复苏(CPR)后患者临床疗效的影响，为提高心肺复苏后临床疗效提供科学方法。

以2015年3月至2018年4月因"心搏骤停"到南京市浦口医院急诊科就诊的40例患者为研究对象，进行前瞻性随机病例对照研究，其中男性33例，女性7例；年龄35-79岁[(56.2±9.8)岁]。将患者随机分为研究组(n＝20例，男17例，女3例)和对照组(n＝20例，男16例，女4例)。对照组仅采取常规复苏治疗，研究组在常规复苏治疗的基础上加用4℃的0.9%氯化钠注射液经(外周或中心)静脉通道或骨髓腔通道注射快速诱导患者呈亚低温状态，并联合体外降温和药物降温维持亚低温的治疗干预，比较两组患者自主循环恢复(Return of spontaneous circulation ，ROSC)后即刻和1 h的直肠温度与温度达标时间，比较两组患者ROSC后即刻、4 h、24 h、48 h、72 h的格拉斯哥昏迷评分(GCS)及动脉血乳酸水平，评估亚低温对两组患者疗效的影响。

研究组患者ROSC后1 h的直肠温度为(34.2±0.4)℃，对照组为(36.8±0.5)℃，两组比较差异有统计学意义(t＝18.3，P<0.05)。两组患者在ROSC后48 h和72 h的GCS评分均较前升高，48h研究组GCS为(8.01±1.12)分，对照组为(6.76±1.85)分，两组比较差异有统计学意义(t＝2.72，P<0.05)。72 h研究组GCS评分为(9.06±1.78)分，对照组为(7.47±1.22)分，两组比较差异有统计学意义(t＝3.41，P<0.05)。两组患者ROSC后4 h、24 h、48 h、72 h的动脉血乳酸水平均呈下降趋势，且在各时间点，研究组患者的动脉血乳酸水平分别为(5.52±1.65)mmol/L、(3.96±1.71)mmol/L、(2.09±1.66)mmol/L、(1.77±1.59)mmol/L；对照组分别为(6.71±1.36)mmol/L、(5.33±1.27)mmol/L、(4.16±1.95)mmol/L、(2.06±1.72)mmol/L，两组各点比较P均<0.05，差异有统计学意义。

CPR术后早期联合采用冰盐水诱导和体外、药物降温的亚低温治疗方法对心搏骤停患者具有良好的临床疗效，值得临床推广应用。

To observe the effect of early mild hypothermia induced by ice saline on the clinical efficacy of patients after cardiopulmonary resuscitation (CPR), and to provide scientific methods for improving the clinical efficacy after cardiopulmonary resuscitation (CPR).

From March 2015 to April 2018, 40 patients with "cardiac arrest" admitted to the emergency department of Nanjing Pukou hospital were selected as the research objects. There were 33 males and 7 females, aged 35-79 years [(56.2±9.8) years]. The patients were randomly divided into study group (n=20, male 17, female 3) and control group (n=20, male 16, female 4). The control group was only given conventional resuscitation therapy, while the study group was added with 0.9% sodium chloride injection at 4 ℃ through (peripheral or central) venous or medullary cavity channels to induce mild hypothermia, combined with external cooling and drug cooling to maintain mild hypothermia, The rectal temperature and the time to reach the standard immediately and 1 h after the return of spontaneous circulation (ROSC) were compared between the two groups. The Glasgow Coma Scale (GCS) and arterial blood lactic acid level were compared immediately, 4 h, 24 h, 48 h, 72 h after ROSC, and the effect of mild hypothermia on the efficacy of the two groups was evaluated.

The rectal temperature of the study group was (34.2±0.4)℃ and that of the control group was (36.8±0.5)℃ 1 h after ROSC, and the difference between the two groups was statistically significant (t=18.3, P<0.05). The GCS scores of the two groups at 48 h and 72 h after ROSC were higher than before. 48 h The GCS score of the study group was(8.01±1.12), and that of the control group was(6.76±1.85). The difference between the two groups was statistically significant (t=2.72, P<0.05). The GCS score of the study group at 72 h was(9.06±1.78), and that of the control group was(7.47±1.22). The difference between the two groups was statistically significant (t=3.41, P<0.05). The arterial blood lactate levels at 4 h, 24 h, 48 h and 72 h after ROSC in the two groups showed a downward trend, and at each time point, the levels of arterial blood lactic acid in the study group were(5.52±1.65)mmol/L, (3.96±1.71)mmol/L, (2.09±1.66)mmol/L, (1.77±1.59)mmol/L; those in the control group were(6.71±1.36)mmol/L, (5.33±1.27)mmol/L, (4.16±1.95)mmol/L and (2.06±1.72)mmol/L, respectively The difference was statistically significant (P<0.05).

The mild hypothermia therapy combined with ice saline induction and external and drug cooling in the early stage after CPR has good clinical effect on patients with cardiac arrest, which is worthy of clinical application.