摘要
目的:探讨呼气末二氧化碳(ETCO_(2))动态变化与接受亚低温治疗(TH)的心肺复苏患者神经预后的关系。方法:回顾性选择2020年1月—2022年1月我院收治的172例接受TH的心肺复苏患者,根据格拉斯哥昏迷量表(GCS)评分分为轻型昏迷组(6~7分,47例)、中型昏迷组(4~5分,79例)和重型昏迷组(≤3分,46例),根据格拉斯哥-匹兹堡脑功能表现分级(CPC)评分分为神经预后良好组(1~2级,62例),神经预后不良组(3~5级,110例)。分别于TH治疗前(T_(0))、治疗12 h(T_(1))、治疗24 h(T_(2))监测ETCO_(2),通过多因素logistic回归分析影响TH心肺复苏患者神经预后的因素,受试者工作特征曲线(ROC)分析ETCO_(2)预测TH心肺复苏患者神经预后的价值。结果:TH治疗后ETCO_(2)逐渐增加(P<0.01),重型昏迷组T_(1)、T_(2)时ETCO_(2)低于中型昏迷组和轻型昏迷组(P<0.05),神经预后不良组T_(1)、T_(2)时ETCO_(2)低于神经预后良好组(P<0.01)。恢复自主循环时间、重型昏迷是TH心肺复苏患者神经预后不良的危险因素(P<0.01),T_(2)ETCO_(2)是保护因素(P<0.01)。T_(2)ETCO_(2)预测TH心肺复苏患者神经预后不良的曲线下面积为0.769(95%CI:0.698~0.829),灵敏度为77.27%,特异度为77.42%。结论:低ETCO_(2)与TH心肺复苏患者昏迷程度加重以及神经预后不良有关,可作为预测神经预后的指标。
Objective: To investigate the relationship between dynamic change of end-tidal carbon dioxide concentration in the expired air(ETCO_(2))and neurological prognosis in patients undergoing therapeutic hypothermia(TH)during cardiopulmonary resuscitation(CPR).Methods: One hundred and seventy-two patients with cardiopulmonary resuscitation patients who received TH and admitted to our hospital from January 2020 to January 2022 were retrospectively selected.According to the Glasgow coma scale(GCS)score these patients were divided into light coma group(6 to 7 points,47 cases),medium coma group(4 to 5 points,79 cases),heavy coma group(≤3 points,46 cases),according to the Glasgow-Pittsburgh brain function performance classification(CPC)score they were divided into neural good prognosis groups(grade 1 to 2,62 cases),poor neurological prognosis group(grade 3 to 5,110 cases).ETCO_(2) was monitored before treatment(T_(0)),12 h(T_(1))and 24 h(T_(2))after TH in patients with TH CPR.Multivariate logistic regression was used to analyze the factors affecting the neurological prognosis of patients with TH CPR,and receiver operating characteristic curve(ROC)was used to analyze the value of ETCO_(2) in predicting the neurological prognosis of patients with TH CPR.Results: After TH treatment,ETCO_(2) increased gradually(P<0.01).The ETCO_(2) of severe coma group at T_(1) and T_(2) was lower than that of moderate coma group and mild coma group(P<0.05).The ETCO_(2) of poor neurological prognosis group at T_(1) and T_(2) was lower than that of good neurological prognosis group(P<0.01).Recovery time of spontaneous circulation and severe coma were risk factors for poor neurological prognosis in patients with TH CPR(P<0.01),while T_(2) ETCO_(2) was protective factor(P<0.01).The area under the curve for T_(2) ETCO_(2) to predict poor neurological prognosis in patients with cardiopulmonary resuscitation who received TH was 0.769(95%CI:0.698-0.829),with a sensitivity of 77.27%and specificity of 77.42%.Conclusion: Low ETCO_(2) is associated with worsening coma degree and poor neurological prognosis in patients with cardiopulmonary resuscitation who received TH,which can be used as a predictor of neurological prognosis.
作者
卢安阳
吕汝琦
LU Anyang;LV Ruqi(Department of Emergency Medicine,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology of China,Mianyang Central Hospital,Mianyang,Sichuan,621000,China)
出处
《临床急诊杂志》
CAS
2022年第8期548-552,共5页
Journal of Clinical Emergency
关键词
呼气末二氧化碳
亚低温
心肺复苏
脑复苏
预后
end-tidal carbon dioxide concentration in the expired air
therapeutic hypothermia
cardiopulmonary resuscitation
brain recovery
prognosis
