心脏骤停后综合征患者机体内环境变化对预后影响的预测模型  

The predictive model for the influence of environment changes in vivo on prognosis in patients with post cardiac arrest syndrome

作　　者：朱永 郭旭昌 林海龙 Zhu Yong;Guo Xuchang;Lin Hailong(Emergency Department,Dongguan East Central Hospital,Dongguan 523000,China)

机构地区：[1]广东省东莞市东部中心医院急诊科,523000

出　　处：《心脑血管病防治》2022年第5期34-38,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：广东省东莞市社会科技发展(一般)项目(202050715035702)。

摘　　要：目的探讨心脏骤停后综合征患者机体内环境变化对预后的影响并建立预测模型指导临床心肺复苏策略。方法回顾性分析东莞市东部中心医院收治的心脏骤停患者的临床资料,均采取集束化管理流程,行血液检测。采用Logistic回归分析法分析各内环境指标水平以及心肺复苏时间对患者预后的影响。结果经Logistic回归分析,白介素-6(IL-6)、血糖(Glu)、肌酐(Scr)、尿素氮(BUN)、凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-D)、心肌肌钙蛋白T(cTnT)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、二氧化碳分压(PaCO_(2))、乳酸(LA)、促肾上腺皮质激素(ACTH)、神经元特异性烯醇化酶(NSE)以及心肺复苏时间均是心脏骤停患者抢救死亡的危险因素(OR=4.246、2.921、3.615、3.854、4.104、3.330、3.473、4.716、4.023、2.998、3.300、4.059、3.418、3.463、3.374、4.778、3.662、4.468、2.998,均P<0.05),纤维蛋白原(FIB)、动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))是其保护因素(OR=0.537、0.484、0.547,均P<0.05);Logistic回归分析显示,IL-6、Glu、PT、APTT、TT、D-D、PaCO_(2)、LA、ACTH、NSE、心肺复苏时间均是心脏骤停患者抢救存活但1年内有神经损伤后遗症的危险因素(OR=4.031、2.617、3.483、3.196、2.995、4.297、2.962、5.165、2.707、4.389、3.785,P<0.05),FIB、PaO_(2)、SaO_(2)是其保护因素(OR=0.630、0.583、0.558,P<0.05)。建立预测模型,心脏骤停患者抢救死亡的预测模型的ROC曲线下面积为0.968,心脏骤停患者经抢救存活、1年内有神经损伤后遗症的预测模型的ROC曲线下面积为0.916。结论IL-6、Glu、Scr、BUN、PT、APTT、TT、FIB、D-D、cTnT、LDH、CK、CK-MB、AST、ALT、PaO_(2)、PaCO_(2)、SaO_(2)、LA、ACTH、NSE等均与心脏骤停后综合征患者的死亡密切相关,且IL-6、Glu、PT、APTT、TT、FIB�Objective To investigate the influence of environment changes in vivo on prognosis of patients with post cardiac arrest syndrome and establish a prediction model to guide the clinical cardiopulmonary resuscitation strategy.Methods The clinical data of patients with cardiac arrest in Dongguan East Central Hospital were retrospectively analyzed,and all patients were treated with cluster management process and blood test.The influences of each internal environmental indicators level and cardiopulmonary resuscitation time on the prognosis of patients were analyzed by multivariate Logistic regression analysis method.Results Logistic regression analysis showed that interleukin-6(IL-6),blood glucose(Glu),creatinine(Scr),urea nitrogen(BUN),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),D-Dimer(D-D),cardiac troponin T(cTnT),lactate dehydrogenase(LDH),creatine phosphate activator(CK),creatine phosphokinase isoenzyme(CK-MB),aspartate aminotransferase(AST),alanine aminotransferase(ALT),partial pressure of carbon dioxide(PaCO_(2)),lactic acid(LA),adrenocorticotropic hormone(ACTH),neuron specific enolase(NSE)and cardiopulmonary resuscitation time were risk factors for death after rescue in patients with sudden cardiac arrest(OR=4.246,2.921,3.615,3.854,4.104,3.330,3.473,4.716,4.023,2.998,3.300,4.059,3.418,3.463,3.374,4.778,3.662,4.468,2.998;all P<0.05),but the fibrinogen(FIB),arterial partial pressure of oxygen(PaO_(2))and blood oxygen saturation(SaO_(2))were protective factors(OR=0.537,0.484,0.547;all P<0.05).Logistic regression analysis showed that IL-6,Glu,PT,APTT,TT,D-D,PaCO_(2),LA,ACTH,NSE and cardiopulmonary resuscitation time were risk factors for neurological sequelae in surviving cardiac arrest patients within 1 year(OR=4.031,2.617,3.483,3.196,2.995,4.297,2.962,5.165,2.707,4.389,3.785;P<0.05),while FIB,PaO_(2),SaO_(2)were protective factors(OR=0.630,0.583,0.558;P<0.05).The prediction models were established.The area under ROC curve of the prediction model for the death despite emerge

关 键 词：心脏骤停后综合征 机体内环境 预后 

分 类 号：R541.78[医药卫生—心血管疾病]