亚低温治疗在脑复苏中的应用及影响预后因素分析  

Mild hypothermia therapy for brain recovery after cardiopulmonary resuscitation and analysis of prognostic factors

作　　者：王国兴[1] 谢苗荣[1] 刘凤奎[1] 王振洲[1] 

机构地区：[1]首都医科大学附属北京友谊医院急诊科,100050

出　　处：《中国危重病急救医学》2010年第10期602-605,共4页Chinese Critical Care Medicine

基　　金：基金项目：北京-东京友好城市文化交流资金支持项目;首都医学发展科研基金资助项目（2002-1007）

摘　　要：目的 探讨影响心肺复苏（CPR）术后亚低温治疗患者预后的因素及动态脑电波监测对预后的价值.方法 对42例循环稳定的CPR术后患者在全身治疗的基础上进行亚低温治疗,体温（颈静脉球温度）控制在31～34℃,维持3～6 d后复温.治疗期间行各项常规检查,同时监测脑电波并进行Hockday分级,对于存活3个月者通过格拉斯哥预后评分（GOS）评估神经系统功能.结果 良好转归组（包括恢复良好、中度残疾,19例）与不良转归组（包括严重残疾、植物状态、死亡,23例）间停跳后至开始CPR时间及复苏后格拉斯哥昏迷评分（GCS）、血中剩余碱、乳酸浓度均存在不同程度差异[停跳后至开始CPR时间（min）：4.11±1.80比13.08±11.37,GCS（分）：5.48±1.32比4.13±1.61,剩余碱（mmol/L）：-10.27±6.23比-13.18±7.29,乳酸（mmol/L）：6.82±3.12比8.47±4.14,P＜0.05或P＜0.01];37例患者行动态脑电波监测,Hockday分级Ⅱ级与Ⅲ级间的良好预后率比较差异有统计学意义[85.7%（12/14）比37.5%（3/8）,P＜0.05].结论 停跳后至开始CPR时间及复苏后GCS、血中剩余碱、乳酸浓度有助于判定亚低温治疗后患者的预后;脑电波监测对判定亚低温治疗后患者神经功能转归有较大帮助.Objective To explore the prognostic factors of mild hypothermia therapy in patients after cardiopulmonary resuscitation （CPR） and the prognostic value of the active electroencephalogram （AEEG）.Methods Mild hypothermia therapy was applied in 42 patients after CRP whose circulation was stable on the basis of systemic treatment. Body temperature （jugular bulb temperature） was controlled at 31 - 34 ℃ for 3 - 6 days before rewarming. During treatment, routine examinations were made, and electroencephalogram was monitored and Hockday grade was estimated. Glasgow outcome scale （GOS） was use to evaluate the nervous system function of patients who survived for 3 months. Results There were varying degrees of difference between the good prognosis group （good recovery, moderate disability, n= 19） and the poor outcome group （severe disability, vegetative state, death, n=23） in the time of CPR after cardiac arrest （minutes： 4. 11±1.80 vs. 13.08±11.37）, Glasgow coma scale （GCS） after the recovery （5.48±1.32 vs.4.13 ± 1.61）, blood base excess （mmol/L： -10. 27±6.23 vs. -13. 18±7. 29） and lactate concentration （mmol/L： 6. 82±3. 12 vs. 8.47±4. 14, P〈0. 05 or P〈0. 01）. There were significant differences between Hockday stage Ⅱ and Ⅲ in the rates of good prognosis in 37 patients who underwent the AEEG monitoring [85.7% （12/14） vs. 37.5% （3/8）, P〈0.05]. Conclusion The duration between CPR and cardiac arrest,GCS after resuscitation, blood base excess and lactate concentration can help determine the prognosis of patients after mild hypothermia therapy; electroencephalogram monitor is a helpful measure to determine the neurological outcome of patients after mild hypothermia therapy.

关 键 词：亚低温 脑复苏 预后 脑电波 

分 类 号：R686[医药卫生—骨科学]