血红蛋白与红细胞分布宽度比值对院外心搏骤停心肺复苏后患者预后的预测价值  

Prognostic value of hemoglobin-to-red cell distribution width ratio in patients with cardiopulmonary resuscitation after out-of-hospital cardiac arrest

作　　者：王宏 兰超[1] 罗垚 张唐娟[1] Wang Hong;Lan Chao;Luo Yao;Zhang Tangjuan(Department of Emergency,the First Affiliated Hospital of Zhengzhou University,Henan Medical Key Laboratory of Emergency and Trauma Research,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州大学第一附属医院急诊科,河南省急诊与创伤研究医学重点实验室,郑州450000

出　　处：《中华危重病急救医学》2023年第9期958-962,共5页Chinese Critical Care Medicine

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202102155)。

摘　　要：目的探讨血红蛋白与红细胞分布宽度比值(HRR)对院外心搏骤停(OHCA)心肺复苏(CPR)后患者预后的预测价值.方法采用回顾性研究方法,选择2016年8月至2022年2月由郑州大学第一附属医院急诊抢救室CPR成功并转入重症监护病房(ICU)的年龄≥18岁的OHCA患者.收集患者一般临床资料,入ICU初次生命体征,入ICU 24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、格拉斯哥昏迷评分(GCS),入ICU后首次实验室指标[包括白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、pH值、血乳酸(Lac)、6 h乳酸清除率(LCR)、红细胞分布宽度(RDW)、HRR],ICU住院时间等.根据是否发生院内死亡将患者分为存活组和死亡组.采用二分类Logistic回归分析CPR后患者预后的独立影响因素;绘制受试者工作特征曲线(ROC曲线)分析独立影响因素对CPR后患者预后的预测价值.结果共入组122例OHCA的CPR后患者,其中院内死亡88例,院内病死率为72.13%.两组患者年龄、既往病史、入ICU初次生命体征、WBC比较差异均无统计学意义.与死亡组比较,存活组GCS评分、RBC、Hb、pH值、6 h LCR、HRR较高,APACHEⅡ评分、Lac、RDW水平较低,ICU住院时间较长.多因素Logistic回归分析显示,APACHEⅡ评分、GCS评分、6 h LCR、HRR、ICU住院时间是CPR后患者预后的独立影响因素[APACHEⅡ评分:优势比(OR)=0.784,95%可信区间(95%CI)为0.683~0.901,P=0.001;GCS评分:OR=1.390,95%CI为1.059~1.823,P=0.018;6 h LCR:OR=1.039,95%CI为1.015~1.064,P=0.001;HRR:OR=2.047,95%CI为1.383~3.029,P<0.001;ICU住院时间:OR=1.128,95%CI为1.046~1.216,P=0.002].ROC曲线分析显示,HRR、6 h LCR和APACHEⅡ评分可以预测CPR后患者的预后,HRR的曲线下面积(AUC)为0.731,截断值为8.555时敏感度为85.3%,特异度为54.5%;6 h LCR的AUC为0.701,截断值为28.947%时敏感度为88.2%,特异度为46.6%;APACHEⅡ评分的AUC为0.848,截断值为22.000分时敏感度为73.9%,特异度为79.4%.HRR与6hLCR联合的预测价�Objective To investigate the prognostic value of hemoglobin-to-red cell distribution width ratio(HRR)in patients with cardiopulmonary resuscitation(CPR)after out-of-hospital cardiac arrest(OHCA).Methods A retrospective study was conducted.Patients aged≥18 years with OHCA who were transferred to intensive care unit(ICU)after successful CPR from the emergency room of the First Affiliated Hospital of Zhengzhou University from August 2016 to February 2022 were enrolled.General clinical data,initial vital signs,acute physiology and chronic health evaluationⅡ(APACHEⅡ),Glasgow coma scale(GCS),first laboratory indicators after admission to ICU[including white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),pH value,lactic acid(Lac),6-hour lactic acid clearance(LCR),red cell distribution width(RDW),HRR],length of ICU stay were collected.According to whether the patients died in hospital,the patients were divided into survival group and death group.Binary Logistic regression was used to analyze the independent factors influencing the prognosis of patients after CPR.Receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of independent influencing factors for the prognosis of patients after CPR.Results A total of 122 patients were enrolled after OHCA CPR,of which 88 died in hospital,the in-hospital mortality was 72.13%.There were no significant differences in age,past medical history,initial vital signs and WBC in ICU between the two groups.Compared with the death group,the survival group had higher GCS score,RBC,Hb,pH value,6-hour LCR,HRR,lower APACHEⅡscore,Lac,RDW level,and longer length of ICU stay.Multivariate Logistic regression analysis showed that APACHEⅡscore,GCS score,6-hour LCR,HRR,length of ICU stay were independent factors influencing the prognosis of patients after CPR[APACHEⅡscore:odds ratio(OR)=0.784,95%confidence interval(95%CI)was 0.683-0.901,P=0.001;GCS score:OR=1.390,95%CI was 1.059-1.823,P=0.018;6-hour LCR:OR=1.039,95%CI was 1.015-1.064,P=0.00

关 键 词：院外心搏骤停 心肺复苏后 血红蛋白 红细胞分布宽度 比值 预后 

分 类 号：R541.78[医药卫生—心血管疾病]