亚低温对心肺复苏患者心肌功能及血气指标的影响  

Effects of mild hypothermia on myocardial function and blood gas indexes in patients with cardiopulmonary resuscitation

作　　者：干金文 金刚[1] 贾昭[1] 魏伟 张建梅[1] 郭涛[2] 马美娟[3] GAN Jinwen;JIN Gang;JIA Zhao;WEI Wei;ZHANG Jianmei;GUO Tao;MA Meijuan(Department of Emergency,Xi'an Aerospace General Hospital,Xi'an,Shaanxi 710100,China;Department of Internal Medicine,the Second People's Hospital of Shaanxi Province,Xi'an,Shaanxi 710000,China;Department of Cardiology,Shaanxi Provincial People's Hospital,Xi'an,Shaanxi 710068,China)

机构地区：[1]西安航天总医院急诊科,陕西西安710100 [2]陕西省第二人民医院内科,陕西西安710000 [3]陕西省人民医院心内科,陕西西安710068

出　　处：《检验医学与临床》2023年第9期1214-1217,1222,共5页Laboratory Medicine and Clinic

基　　金：陕西省重点研发计划项目(2021SF-329)。

摘　　要：目的探讨心肺复苏患者以亚低温治疗对其心肌功能以及血气指标的影响。方法选取西安航天总医院2017年1月至2022年1月收治的心搏骤停后以心肺复苏成功救治的患者80例为研究对象,按照随机数字表法,将其分为观察组和对照组,各40例。对照组患者仅接受心肺复苏,观察组患者则在此基础上进行亚低温治疗,两组患者均持续随访10 d。比较两组患者复苏后1、3 d美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷量表(GCS)评分及序贯器官衰竭评估(SOFA)评分,复苏前及复苏后6 h心肌功能,复苏前及复苏后30 min血气指标,以及随访期间并发症发生情况。结果复苏后3 d两组患者NIHSS、SOFA评分低于复苏后1 d,GCS评分高于于复苏后1 d,且观察组复苏后3 d NIHSS、SOFA评分低于对照组,GCS评分高于对照组,差异均有统计学意义(P<0.05)。复苏后6 h两组患者血清心肌肌钙蛋白I、肌酸激酶、肌酸激酶同工酶、羟丁酸脱氢酶水平低于复苏前,且观察组低于对照组,差异均有统计学意义(P<0.05)。与复苏前比较,复苏后30 min两组患者氧分压(PaO_(2))、血氧饱和度(SaO_(2))、氧合指数(PaO_(2)/FiO_(2))水平升高,二氧化碳分压(PaCO_(2))水平降低,且观察组复苏后30 min PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)水平高于对照组,PaCO_(2)水平低于对照组,差异均有统计学意义(P<0.05)。随访期间,观察组并发症总发生率[10.00%(4/40)]低于对照组[27.50%(11/40)](P<0.05)。结论心肺复苏患者以亚低温进行治疗能有效减轻神经功能缺损及意识障碍,恢复心肌功能,改善血气指标,且安全性更高。Objective To investigate the effects of mild hypothermia on myocardial function and blood gas indexes in cardiopulmonary resuscitation patients.Methods A total of 80 patients who were successfully trea-ted with cardiopulmonary resuscitation after cardiac arrest in Xi'an Aerospace General Hospital from January 2017 to January 2022,were selected and divided into the observation group and the control group according to random number table method,40 cases in each group.The control group only received cardiopulmonary resus-citation,and the observation group received mild hypothermia on the basis of the cardiopulmonary resuscita-tion.Both groups were followed up for 10 days.The national institutes of health stroke scale(NIHSS)score,glasgow coma scale(GCS)score,and sequential organ failure assessment(SOFA)score 1 and 3 days after re-suscitation,myocardial function before and 6 hours after resuscitation,blood gas indexes before and 30 min af-ter resuscitation,and complications during follow-up were compared between the two groups.Results Com-pared with 1 day after resuscitation,the NIHSS and SOFA scores 3 days after resuscitation of the two groups,decreased,GCS score increased,meanwhile the NIHSS and SOFA scores 3 days after resuscitation of the ob-servation group were lower than those of the control group,and the GCS score was higher than that of the control group,the differences had statistical significance(P<0.05).The serum levels of cardiac troponin I,creatine kinase,creatine kinase isoenzyme and hydroxybutyrate dehydrogenase 6 hous after resuscitation in both groups were lower than those before resuscitation,and which of the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).Compare with before re-suscitation,the levels of oxygen partial pressure(PaO_(2)),oxygen saturation(SaO_(2))and oxygenation index(PaO_(2)/FiO_(2))30 min after resuscitation in both groups increased,the level of partial pressure of carbon diox-ide(PaCO_(2))decreased,and the levels o

关 键 词：心搏骤停 心肺复苏 亚低温 心肌功能 血气指标 

分 类 号：R605.974[医药卫生—急诊医学]