心脏停搏抢救过程中维持血压对近期预后的影响  

The effect of blood pressure during resuscitation on the short term outcome of patients suffered from cardiac arrest

作　　者：邢学忠[1] 王海军[1] 曲世宁[1] 张昊[1] 黄初林[1] 王浩 杨全会[1] 高勇[1] 

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院重症医学科,北京100021

出　　处：《中国急救医学》2016年第5期415-418,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的研究心脏停搏过程中血压的水平对近期预后的影响。方法回顾分析2011-01～2015—09间因心脏停搏转人中国医学科学院肿瘤医院重症医学科（intensive care unit，ICU）抢救治疗的19例患者。结果3例患者家属放弃抢救，最终16例进行分析。16例患者中男性11例，女性5例，年龄（57±14）岁。16例患者中24h时存活8例，死亡8例。单因素分析发现：与存活组相比，死亡组的患者转入ICU时的器官衰竭评分（sequential organ failure assessment, SOFA） 更高[（13±2）分vs．（8±5）分，P=0．037]、心脏停搏前更多地存在低血压（75％vs．12．5％，P=0．012）、肾上腺素用量更多[（5±4）mg vs．（2±2）mg，P=0．043]、复苏时平均动脉压（mean blood pressure，MAP）更低[（57±14）mm Hg vs．（76±11）mmHg，P=0．008）。受试者操作曲线receiver operating curve，ROC）分析发现，复苏时平均动脉压在62mmHg时预测24h存活的敏感度为100％，特异度75％（曲线下面积为0．883±0．088，95％可信区间0．711～1．055，P=0．010）。根据复苏时MAP是否〉62mmHg分为两组，分析发现，与MAP〈62mmHg的患者比较，MAP〉62mmHg组的患者出院时脑功能评分无显著改善，但是病死率显著下降（50％比100％，P=0．037）。结论对于院内心脏停搏的患者，复苏时维持一定的平均动脉压，可以改善患者24h存活率和30d病死率，但不改善脑功能评分。Objective To investigate the effect of blood pressure during resuscitation on the short term outcome of patients suffered from cardiac arrest. Methods Data of 19 patients with cardiac arrest who admitted to Intensive Care Unit of Cancer Hospital of Chinese Academy of Medical Sciences from January 2011 to September 2015 were retrospectively collected and analyzed. Results Three patients withdrew and 16 patients received resuscitation. There were 11 males and 5 females with a mean age of 57 years. Of 16 patients, 8 patients died within 24 hours after admission and 8 patients survived. Univariable analysis demonstrated that patients died within 24 hours were more severe as reflected by sequential organ failure assessment （SOFA） score （13±2 vs. 8＋5, P = 0.037）, and they had more hypotension （75% vs. 12.5%, P=0.012）, received more dosage of epinephrine [（5 ±4） mg vs. （2±2） rag, P = 0.043] and had lower mean blood pressure [（57±14） mm Hg vs. （76± 11） mm Hg, P = 0.008]compared with patients survived. Receiver operating curve analysis showed that the cutoff value of MAP during resuscitation in predicting the survival within 24 hours was 62 mm Hg, with a sensitivity of 100%, and a specificity of 75% （area under the curve was 0.883±0.088, 95% confidential interval： 0.711-1.055, P = 0.010）. Patients with MAP greater than 62 mm Hg had no improvement in cerebral performance category on discharge, but lower in-hospital mortality （50% vs. 100%, P = 0.037） compared with patients whose MAP was less than 62 mm Hg. Conclusion For patients suffered cardiac arrest, maintaining MAP level greater than 62 mm Hg during resuscitation may improve the 24 hour survival and in-hospital mortality, but not cerebral performance category.

关 键 词：心脏停搏 心肺复苏(CPR) 血压 预后 平均动脉压(MAP) 

分 类 号：R541.78[医药卫生—心血管疾病]