离子钙水平联合乳酸清除率对心肺复苏后患者近期预后的评估  

Assessment of ionized calcium levels combined with lactate clearance for the immediate prognosis of patients after cardiopulmonary resuscitation

作　　者：邹洋洋 姚莉[1] ZOU Yangyang;YAO Li(Department of Intensive Care Unit,the Second People's Hospital of Hefei,Hefei,230011,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：《临床急诊杂志》2023年第11期573-577,共5页Journal of Clinical Emergency

基　　金：合肥市第二人民医院院级课题(No:2021ygkt43)。

摘　　要：目的:探讨心肺复苏(cardiopulmonary resuscitation,CPR)后患者早期采用动脉离子钙(ionized calcium,iCa)水平联合乳酸清除率对其近期预后的评估价值。方法:回顾性分析合肥市第二人民医院重症医学2018年6月—2020年6月收治的CPR后患者临床资料,包括既往基础疾病、肾上腺素用量、初始乳酸值、iCa水平、乳酸清除率、APACHEⅡ评分,根据CPR后7 d的转归将患者分为存活组和死亡组。采用t/χ2检验比较两组各指标之间差异,并通过建立logistic回归方法分析其与预后的关系,绘制受试者工作曲线(receiver operating curve,ROC)分析对患者预后的判断价值。结果:共纳入121例患者,存活组有43例(35.5%),死亡组有78例(64.5%);两组的既往疾病、肾上腺素用量、初始乳酸值比较,差异无统计学意义(均P>0.05);年龄、入院APACHE II评分、iCa及6 h乳酸清除率比较,差异有统计学意义(均P<0.05);多因素logistic回归分析显示,APACHEⅡ评分(OR=0.745,95%CI:0.648~0.856)、乳酸清除率(OR=1.100,95%CI:1.050~1.152)、iCa水平(OR=9.184,95%CI:3.196~26.391)是CPR后患者7 d病死率的独立预测因素(均P<0.05)。iCa、乳酸清除率以及联合两者与APACHEⅡ评分预测概率的曲线下面积分别为0.735(95%CI:0.646~0.827)、0.709(95%CI:0.606~0.811)、0.832(95%CI:0.755~0.910)、0.832(95%CI:0.754~0.910)。结论:iCa水平联合6 h乳酸清除率对CPR后患者近期预后(7 d病死率)具有良好的预测价值。Objective To investigate the value of early use of arterial ionized calcium(iCa)levels combined with lactate clearance in patients after cardiopulmonary resuscitation for the assessment of their immediate prognosis.Methods The clinical data of post-resuscitation patients admitted to the Second People's Hospital of Hefei for critical care medicine from June 2018 to June 2020 were retrospectively analyzed,including previous underlying diseases,epinephrine dosage,initial lactate,iCa level,lactate clearance,and APACHEⅡscore,and the patients were divided into survival and death groups according to the regression at 7 d after resuscitation.The t/χ2 test was used to compare the indexes in the two groups,and the relationship between them and prognosis were analyzed by establishing a logistic regression method,and the receiver operating curve(ROC curve)was plotted to analyze the value of predicting the prognosis of the patients.Results A total of 121 patients were included,with 43 cases(35.5%)in the survival group and 78 cases(64.5%)in the death group.The differences were not statistically significant when comparing previous disease,epinephrine dosage,and initial lactate between the two groups(all P>0.05).The differences were statistically significant when comparing age,admission APACHEⅡscore,iCa,and 6 h lactate clearance(all P<0.05).Multivariate logistic regression analysis showed that APACHEⅡscore(OR=0.745,95%CI:0.648-0.856),lactate clearance rate(OR=1.100,95%CI:1.050-1.152),and iCa level(OR=9.184,95%CI:3.196-26.391)were independent predictors for 7-d morbidity of post-resuscitation patients(all P<0.05).The area under the curve of iCa,lactate clearance,combining both and APACHEⅡscore were 0.735(95%CI:0.646-0.827),0.709(95%CI:0.606-0.811),0.832(95%CI:0.755-0.910)and 0.832(95%CI:0.754-0.910).Conclusion iCa levels combined with 6 h lactate clearance had good predictive value for the near-term prognosis(7 d morbidity)of patients after cardiopulmonary resuscitation.

关 键 词：心肺复苏术 心搏骤停后综合征 乳酸 低钙血症 预后 

分 类 号：R459.7[医药卫生—急诊医学]