院内心脏骤停后自主循环恢复患者短期预后的危险因素与列线图预测模型构建  

The risk factors of short-term prognosis and the construction of nomogram prediction model in the patients with restoration of spontaneous circulation after in-hospital cardiac arrest

作　　者：段文慧 杨晶 王爱文 王玮玮 成亚东 王杨周 Duan Wenhui;Yang Jing;Wang Aiwen;Wang Weiwei;Cheng Yadong;Wang Yangzhou(Department of Critical Care Medicine,Changzhi People's Hospital,Changzhi 046000,China)

机构地区：[1]长治市人民医院重症医学科,山西长治046000 [2]长治市人民医院急诊科,山西长治046000

出　　处：《中国急救医学》2024年第3期246-251,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨院内心脏骤停(in-hospital cardiac arrest,IHCA)后自主循环恢复(restoration of spontaneous circulation,ROSC)患者短期预后的危险因素,并构建其预后的列线图预测模型。方法 选取2020年6月至2023年10月就诊于长治市人民医院重症医学科IHCA后ROSC的126例患者,根据7 d预后情况分为生存组(n=42)和死亡组(n=84)。收集并比较两组患者的基线临床资料及相关研究指标。采用Logistic回归分析筛查影响IHCA患者7 d预后的相关因素,最后构建IHCA患者7 d死亡的列线图预测模型,使用C指数、校准曲线和决策曲线分析(DCA)对预测模型进行评价。结果 126例患者中7 d死亡患者84例,病死率为66.67%。两组间急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分差异有统计学意义,死亡组显著升高(P<0.05)。进一步比较发现,与生存组比较,死亡组Lac 6 h显著升高、CPR持续时间更长(均P<0.05),同时,死亡组留置有创动脉导管、可除颤心律及肾上腺素用量<5 mg的人数显著减少(均P<0.05)。单因素Logistic回归分析提示,APACHEⅡ评分、6 h Lac、CPR持续时间及有创动脉、可除颤心律、肾上腺素用量是IHCA患者7 d死亡的相关危险因素,进一步多因素Logistic回归分析后提示6 h Lac(OR=1.243,95%CI 1.085~1.425)、有创动脉(OR=5.839,95%CI 1.820~18.734)、CPR持续时间(OR=1.084,95%CI 1.023~1.148)、可除颤心律(OR=9.418,95%CI 2.596~34.172)和肾上腺素用量(OR=4.366,95%CI 1.178~16.182)仍是影响患者预后的独立危险因素(均P<0.05)。最后,基于上述指标构建的列线图模型C指数为0.931,区分度好,H-L拟合优度检验P>0.05,且校正曲线接近于理想曲线,校准度高。DCA曲线分析进一步证实该预测模型有良好的临床应用价值。结论 基于6 h Lac、有创动脉、CPR持续时间、可除颤心律和肾上腺素用量构建的列线图预测模型可用于评估IHCA后ROSC患者7 d的死亡风险。Objective To investigate the risk factors of short-term prognosis in the patients with restoration of spontaneous circulation(ROSC) after in-hospital cardiac arrest(IHCA) and to construct a prognosis prediction model based on nomogram.Methods A total of 126 patients with ROSC after IHCA in the Intensive Care Unit of Changzhi People's Hospital from June 2020 to October 2023 were selected as the study objects,and were divided into survival group(n=42) and death group(n=84) according to 7-day prognosis.The baseline clinical data and relevant research indicators of the two groups were collected and compared between the two groups.Logistic regression was used to analyze the relevant variables affecting the 7-day prognosis of patients with ROSC after IHCA.Finally,a nomogram prediction model for the 7-day death of IHCA patients was constructed,and the prediction model was evaluated by C-index,calibration curve and decision curve.Results A total of 126 patients met the inclusion criteria,of which 84 died within 7 days,a mortality rate was 66.67%.Compared with the survival group,the acute physiology and chronic health evaluation(APACHE)Ⅱ score in the death group were significantly increased(P<0.05).Further comparison showed that 6 h lactate(Lac) was significantly higher and the duration of CPR was longer in the death group compared with the survival group(all P<0.05).Compared with the survival group,the number of patients with invasive catheterization,defibrillable rhythm and epinephrine dosage<5 mg in the death group was significantly reduced(all P<0.05).Univariate Logistic regression analysis indicated that APACHEⅡ score,6 h Lac,the duration of CPR,invasive artery,defibrillable rhythm,and the dosage of epinephrine were risk factors for the 7-day death in IHCA patients.Further multivariate Logistic regression analysis indicated that 6 h Lac(OR=1.243,95%CI 1.085-1.425),invasive artery(OR=5.839,95%CI 1.820-18.734),the duration of CPR(OR=1.084,95%CI 1.023-1.148),defibrillable rhythm(OR=9.418,95%CI 2.596-34.172) and epin

关 键 词：院内心脏骤停 心肺复苏 自主循环恢复 乳酸 有创动脉 可除颤心律 肾上腺素用量 列线图 

分 类 号：R459.7[医药卫生—急诊医学]