心脏骤停后患者外周血细胞变化与预后的相关性  

Correlation between the changes of peripheral blood cells and the prognosis of patients after cardiac arrest

作　　者：白颐 田慈[1] 翟樯榕 李姝[1] 张华[1] 马青变[1] Bai Yi;Tian Ci;Zhai Qiang-rong;Li Shu;Zhang Hua;Ma Qing-bian(Emergency Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院急诊科,北京100191

出　　处：《中国急救医学》2021年第5期380-385,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探究心脏骤停后患者外周血细胞变化与近期预后的相关性。方法回顾性收集2016年至2019年因心脏骤停就诊于我院急诊科并自主循环恢复(ROSC)患者中符合纳入标准的98例患者人口学、基础疾病、心肺复苏相关信息以及ROSC后即刻(0 h)、8 h、12 h、24 h、48h、72 h血常规和0 h凝血功能。根据出院是否存活将患者分为存活出院组(n=27)与死亡组(n=71),对外周血细胞指标进行统计分析,观察其与预后的相关性。结果样本总体白细胞计数在ROSC后8 h达峰[15.2(10.4~22.8)×10^(9)/L]后逐渐下降,至72 h仍高于正常值;淋巴细胞绝对数在ROSC后即出现显著下降,至12 h达最低值[0.6(0.5~0.9)×10^(9)/L];中性粒细胞绝对数在ROSC后早期即出现显著上升,至72 h[8.9(6.9~12.8)×10^(9)/L]仍高于正常水平;血小板计数在ROSC后出现缓慢下降趋势,但均在正常范围,上述变量各时间点与0 h比较差异有统计学意义(P<0.05)。死亡组患者外周血淋巴细胞绝对数较存活出院组更低,且两组患者外周血淋巴细胞绝对数在ROSC后24 h差异有统计学意义[0.7(0.5~0.9)×10^(9)/L vs.0.9(0.8~1.2)×10^(9)/L,P<0.05];死亡组患者血小板计数在ROSC后8~72 h均低于存活出院组(P<0.05)。结论心脏骤停患者在ROSC后24 h淋巴细胞绝对数降低、8~72 h血小板计数降低,与院内死亡结局相关。Objective To explore the correlation between peripheral blood cells and the short-term prognosis of cardiac arrest patients after return of spontaneous circulation(ROSC).Methods This study retrospectively collected and analyzed the data including the demographics,comorbidity,cardiopulmonary resuscitation information and laboratory findings(blood routine tests and coagulation)at 0,8,12,24,48 and 72 h after ROSC in cardiac arrest patients who met inclusion criteria admitted in our emergency department from 2016 to 2019.Patients were divided into the death group(n=71)and the survival group(n=27)according to whether they were survived to discharge.Peripheral blood cell indicators were statistically analyzed in order to investigate the correlation with the short-term prognosis.Results The white blood cell count gradually decreased after reaching the peak at 8 h[15.2(10.4-22.8)×10^(9)/L]and was still higher than the normal range at 72 h.The absolute lymphocyte count decreased significantly after ROSC and reached the lowest value at 12 h[0.6(0.5-0.9)×10^(9)/L].The absolute neutrophils count increased significantly after ROSC,and was still higher than the normal range at 72 h[8.9(6.9-12.8)×10^(9)/L].The platelet count showed a slow downward trend after ROSC,but the counts were in the normal range within 72 h.There were statistically significant differences in the above variables between different time points and the immediate time(0 h)after ROSC(P<0.05).In comparison between the two groups,the absolute lymphocyte count was lower in the death group,and there was a statistical difference in the absolute lymphocyte count at 24 h after ROSC between the two groups[0.7(0.5-0.9)×10^(9)/L vs.0.9(0.8-1.2)×10^(9)/L,P<0.05].The platelet count at 8-72 h after ROSC was lower in the death group than in the survival group(P<0.05).Conclusions In our study,the absolute lymphocyte count at 24 h and platelet count from 8 h to72 h after ROSC decrease and are related to hospital death in cardiac arrest patients.

关 键 词：心脏骤停(cardiac arrest CA) 心脏骤停后综合征(PCAS) 外周血细胞 预后 

分 类 号：R541.78[医药卫生—心血管疾病]