心肺复苏后动脉血二氧化碳分压与神经功能预后的关系  

Relationship between arterial blood partial pressure of carbon dioxide and prognosis of neurological function after cardiopulmonary resuscitation

作　　者：邹洋洋 陈婷[1] 姚莉[1] Zou Yangyang;Chen Ting;Yao Li(Intensive Care Unit,the Second People's Hospital of Hefei,Hefei 230011,Anhui Province,China)

机构地区：[1]合肥市第二人民医院重症医学科,合肥230011

出　　处：《中国基层医药》2023年第5期714-718,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：安徽省合肥市卫生健康应用医学研究项目(合卫科教〔2019172〕号);安徽省合肥市第二人民医院院级课题(2021ygkt43)。

摘　　要：目的探讨心肺复苏后患者早期动脉血二氧化碳分压(PaCO_(2))与出院时神经功能预后的关系。方法回顾性分析合肥市第二人民医院重症医学和急诊科2018年1月至2020年1月收治的心肺复苏后患者116例的临床资料,根据入科后24h内的平均PaCO_(2),将患者分为正常组[35 mmHg≤PaCO_(2)≤55 mmHg(1 mmHg=0.133 kPa)]44例、高碳酸血症组(PaCO_(2)>55 mmHg)51例和低碳酸血症组(PaCO_(2)<35 mmHg)21例。比较各组患者预后指标:住ICU时间、住院病死率及出院时神经功能预后。并通过建立logistic回归分析模型,明确PaCO_(2)与神经功能预后的关系。结果三组年龄、性别、心脏骤停时间、入院时急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、1 h平均动脉压(MAP)及心脏骤停发生地点和初始心律等差异均无统计学意义(均P>0.05)。正常组ICU住院时间[(7.23±2.55)d]短于高碳酸血症组[(12.21±4.12)d]、低碳酸血症组[(11.78±4.72)d],差异均有统计学意义(t=6.48、4.59,均P<0.01);正常组院内病死率为38.6%(17/44),低于高碳酸血症的60.8%(31/51)、低碳酸血症组的66.7%(14/21),差异均有统计学意义(χ^(2)=4.63、4.47,均P<0.05);正常组出院神经预后良好率为55.6%(15/44),高于高碳酸血症的25.0%(5/51)、低碳酸血症组的28.6%(2/21),差异均有统计学意义(χ^(2)=8.38、5.14,均P<0.05)。多因素logistic回归分析显示,心跳骤停时间、MAP、APACHEⅡ评分、PaCO_(2)是复苏后患者出院神经功能预后的重要因素(均P<0.01)。结论在心肺复苏后24 h内,维持正常的PaCO_(2)有利于改善患者出院时神经功能。Objective To investigate the relationship between arterial blood partial pressure of carbon dioxide and neurological outcome after cardiopulmonary resuscitation.Methods The clinical data of 116 patients who underwent cardiopulmonary resuscitation admitted to the Intensive Care Unit and Emergency Department of the Second People's Hospital of Hefei from January 2018 to January 2020 were retrospectively analyzed.According to the average arterial blood partial pressure of carbon dioxide within 24 hours after admission,patients were divided into normal(35 mmHg≤PaCO_(2)≤55 mmHg,1 mmHg=0.133 kPa,n=44),hypercapnia(PaCO_(2)>55 mmHg,n=51),and hypocapnia(PaCO_(2)<35 mmHg,n=21)groups.ICU stay,in-hospital mortality,and neurological outcome at discharge were compared among groups.A logistic regression analysis model was established.The relationship between PaCO_(2) and neurological outcome was determined.Results There were no significant differences in age,sex,cardiac arrest time,acute physiological and chronic health evaluation II score at admission,1-hour mean arterial pressure,location of cardiac arrest,and initial heart rhythm among the three groups(all P>0.05).ICU stay in the normal group[(7.23±2.55)days]was significantly higher than that in the hypercapnia[(12.21±4.12)days]and hypocapnia[(11.78±4.72)days]groups(t=6.48,4.59,both P<0.01).In-hospital mortality in the normal group was 38.6%(17/44),which was significantly lower than 60.8%(31/51)in the hypercapnia group and 66.7%(14/21)in the hypocapnia group(χ^(2)=4.63,4.47,both P<0.05).The good neurological outcome rate in the normal group was 55.6%(15/44),which was significantly higher than 25.0%(5/51)in the hypercapnia group and 28.6%(2/21)in the hypocapnia group(χ^(2)=8.38,5.14,both P<0.05).Multivariate logistic regression analysis showed that cardiac arrest time,1-hour mean arterial pressure,acute physiological and chronic health evaluation II score,and PaCO_(2) are important factors for neurological outcomes of resuscitated patients at discharge(all P<0.01).Con

关 键 词：心脏停搏 心肺复苏术 血气监测 经皮 二氧化碳 高碳酸血 低碳酸血症 脑损伤 预后 

分 类 号：R459.7[医药卫生—急诊医学]