PETCO2对腹部提压CPR救治效果及血清S100B蛋白对脑功能预测价值的研究  

Predictive value of partial pressure of end-tidal carbon dioxide on the effect of active abdominal compression-decompression cardiopulmonary resuscitation and serum S100B protein on cerebral function

作　　者：汪宏伟 沙鑫 张思森 焦宪法 赵龙现[2] 岑颖欣 宋维[3] 李静 王立祥[5] 

机构地区：[1]南方医科大学附属郑州人民医院急诊与重症医学科,河南郑州450003 [2]三门峡市中心医院急诊科,河南三门峡472000 [3]海南省人民医院急诊医学中心,海南海口570311 [4]北京德美瑞医疗设备有限公司,100038 [5]中国武警总医院急救医学中心,北京100039

出　　处：《中华危重病急救医学》2018年第2期117-122,共6页Chinese Critical Care Medicine

基　　金：河南省医学科技重点攻关计划项目（201303221）;河南省郑州市创新型科技领军人才计划项目（131PLJRC682）;河南省郑州市科技攻关计划项目（20140452）

摘　　要：目的探讨呼气末二氧化碳分压（PETCO2）对腹部提压心肺复苏（AACD-CPR）的复苏效果及血清S100B蛋白对成功复苏患者脑功能的预测价值。方法选择2014年9月至2017年12月南方医科大学附属郑州人民医院收治的实施AACD-CPR的142例院内心搏骤停（IHCA）成人患者，根据自主循环恢复（ROSC）与否将患者分为成功组和失败组；再根据复苏成功后1个月格拉斯哥-匹兹堡脑功能（CPC）分级将复苏成功患者分为预后良好组（CPC 1～2级）和预后不良组（CPC 3～5级）。分析患者复苏过程中血流动力学、动脉血气指标、PETCO2、血清S100B蛋白水平的变化（以25例健康者S100B蛋白水平作为正常参考值）；用受试者工作特征曲线（ROC）分析PETCO2对AACD-CPR的复苏效果及血清S100B蛋白对成功复苏患者脑功能的预测价值。结果①根据传统定性指标如触及大动脉搏动、口唇及四肢末梢变红润、可见胸廓自行上下起伏、瞳孔较前缩小、对光反射存在等判断，142例IHCA患者成功复苏54例；通过PETCO2指导CPR，最后成功复苏57例，两者对比差异无统计学意义（χ2＝0.133，P＝0.715）。142例IHCA患者随AACD-CPR的进行，动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）均有不同程度改善；ROSC 20 min时心率（HR）、平均动脉压（MAP）、PaO2、PaCO2均较复苏过程中进一步改善。复苏开始时，成功组和失败组PETCO2约为10 mmHg（1 mmHg＝0.133 kPa）；成功组PETCO2随CPR的进行逐渐上升到20 mmHg以上，而失败组则在2～5 min内稍升高后逐渐下降至20 mmHg以下，两组CPR各时间点PETCO2比较差异有统计学意义。用CPR 20 min PETCO2预测复苏结局的ROC曲线下面积（AUC）为0.969，95%可信区间（95%CI）为0.943～0.995（P＝0.000），最佳临界值为24.25 mmHg时，敏感度为90.7%，特异度为96.6%。②预后良好组和预后不良组ROSC 0.5 h时S100B蛋白水平均较健康�ObjectiveTo explore the predictive value of partial pressure of end-tidal carbon dioxide （PETCO2） on the effect of active abdominal compression-decompression cardiopulmonary resuscitation （AACD-CPR） and serum S100B protein on cerebral function.Methods142 adult patients with in-hospital cardiac arrest （IHCA） AACD-CPR in Zhengzhou People＇s Hospital, Affiliated Southern Medical University from September 2014 to December 2017 were enrolled. Patients were divided into successful group and failure group according to restoration of spontaneous circulation （ROSC） or not; and then according to Glasgow-Pittsburgh cerebral performance categories （CPC） one month after ROSC, the successful group was divided into good prognosis group （CPC 1-2） and poor prognosis group （CPC 3-5） further. The variations of hemodynamic, arterial blood gas index, PETCO2 and serum S100B protein level （25 healthy subjects as normal S100B protein level reference value） during the recovery were analyzed. The predictive value of PETCO2 on the effect of AACD-CPR and serum S100B protein on cerebral function of successful resuscitation patients were analyzed by receiver operating characteristic curve （ROC）.Results① According to the traditional qualitative indexes, such as pulsation of the large artery, redness of lips and extremities, spontaneous fluctuation of chest, narrowing of pupil, existence of shallow reflex, etc, 54 in 142 patients with IHCA were successfully resuscitated; 57 cases were successfully resuscitated through the guidance of PETCO2, there was no significant difference between the two groups （χ2 = 0.133, P = 0.715）. With the AACD-CPR, 142 CA patients＇ arterial partial pressure of oxygen （PaO2）, arterial blood carbon dioxide partial pressure （PaCO2） were all improved with different degrees; heart rate （HR）, mean arterial pressure （MAP）, PaO2 and PaCO2 were further improved at 20 minutes after ROSC. At beginning of AACD-CPR, PETCO2 of both groups were about 10 mmHg （1 mmHg =

关 键 词：腹部提压 心肺复苏 自主循环恢复 呼气末二氧化碳分压 S100B蛋白 

分 类 号：R459.7[医药卫生—急诊医学]