经颅多普勒超声联合SjvO_(2)对CA-ROSC患者神经功能预后的评估价值  

Value of Transcranial Doppler Combined with SjvO_(2) in Evaluating the Prognosis of Neurological Function of Patients with CA-ROSC

作　　者：魏伟 干金文 金刚[1] 贾昭[1] 张建梅[1] 李娜[1] 袁晶 田国欣 张连英 刘晓曼 WEI Wei;GAN Jinwen;JIN Gang;JIA Zhao;ZHANG Jianmei;LI Na;YUAN Jing;TIAN Guoxin;ZHANG Lianying;LIU Xiaoman(Xi’an Aerospace General Hospital,Xi’an 710100,China;不详)

机构地区：[1]西安航天总医院,陕西西安710100 [2]西安国际医学中心

出　　处：《中外医学研究》2022年第18期21-25,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨经颅多普勒超声(TCD)联合颈内静脉球血氧饱和度(SjvO_(2))监测对心脏骤停后恢复自主循环(CA-ROSC)患者神经功能预后的评估价值。方法:选取2017年8月-2020年8月西安航天总医院急诊抢救室和重症监护室CA-ROSC患者60例,根据患者从急诊抢救室和重症监护室出科时格拉斯哥-匹兹堡脑功能分级(CPC),将其分为神经功能良好组(n=15)、不良组(n=45),比较两组患者临床资料、SjvO_(2)和TCD等参数,对神经功能预后评估绘制受试者工作特征(ROC)曲线,评估各项指标对患者神经功能预后的预测效能。结果:神经功能良好组SjvO_(2)、CA-ROSC时间、体外膜肺氧合治疗(ECMO)辅助时间均明显低于神经功能不良组(P<0.05);神经功能良好组大脑动脉搏动指数(PI)和阻抗指数(RI)明显低于神经功能不良组,而收缩期峰值血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm)和脑血流量(CBF)明显高于神经功能不良组(P<0.05)。ROC曲线分析显示,左侧CBF、右侧CBF、SjvO_(2)单独监测的曲线下面积依次为0.803、0.790、0.650,最佳截断值分别为5.96 ml/min、5.98 ml/min、75.15%时,三者的敏感度分别为60.00%、66.67%、46.67%,特异度分别为100%、100%、93.33%;三者联合预测的曲线下面积为0.896,明显高于左侧CBF、右侧CBF、SjvO_(2)单独监测(P<0.05),经Logistic回归获得联合预测模型,联合预测的最佳截断值为0.750时,其敏感度、特异度为80.00%、93.33%。结论:TCD联合SjvO_(2)监测可进一步提高CA-ROSC患者神经功能预后的临床预测准确性,提供更高指导价值的参考信息。Objective:To discuss the value of transcranial doppler(TCD)combined with jugular venous oxygen saturation(SjvO_(2))monitor in evaluating neurological function prognosis of patients with cardiac arrest return of spontaneous circulation(CA-ROSC).Method:A total of 60 patients with CA-ROSC admitted to emergency room and intensive care unit of the Xi’an Aerospace General Hospital from August 2017 to August 2020 were selected.According to the Glasgow-brain function classification of Pittsburgh(CPC)at discharge from emergency room and intensive care unit,the patients enrolled were divided into good neurological function group(n=15)and poor neurological function group(n=45).The clinical data,SjvO_(2)and TCD parameters were compared between the two groups.The prognosis of neurological function was evaluated by drawing the receiver operating characteristic(ROC)curve,the predictive efficacy of various indicators on the prognosis of neurological function was evaluate.Result:The SjvO_(2),CA-ROSC time and the extracorporeal membrane oxygenation(ECMO)time of the good neurological function group were significantly shorter than those of the poor neurological function group(P<0.05).Cerebral artery pulsatility index(PI)and resistance index(RI)of the good neurological function group were significantly lower than those of the poor neurological function group,while the peak systolic blood flow velocity(Vs),diastolic blood flow velocity(Vd),mean blood flow velocity(Vm)and cerebral blood flow(CBF)were significantly higher than those of the poor neurological function group(P<0.05).ROC curve analysis showed that the area under the curve values of left CBF,right CBF,and SjvO_(2)alone were 0.803,0.790 and 0.650,respectively.The optimal cut-off values were 5.96 ml/min,5.98 ml/min,and 75.15%,respectively.The sensitivity of the three was 60.00%,66.67%and 46.67%,respectively.The specificity was 100%,100%and 93.33%respectively.The area under the curve predicted of the three in combination was 0.896,which significantly higher than that of left

关 键 词：心脏骤停 经颅多普勒超声 颈内静脉球血氧饱和度 预后 

分 类 号：R459.7[医药卫生—急诊医学]