高氧暴露对心脏骤停复苏后患者院内死亡率和神经功能预后影响  

Effect of hyperoxia exposure on in-hospital mortality and neurological outcomes in patients resuscitated from cardiac arrest

作　　者：王爱民[1] 王楠 李湘民[1] 张牧 黄国庆[1] WANG Aimin;WANG Nan;LI Xiangmin;ZHANG Mu;HUANG Guoqing(Department of Emergency,Xiangya Hospital,Central South University,Changsha,410008,China)

机构地区：[1]中南大学湘雅医院急诊科,长沙410008

出　　处：《临床急诊杂志》2024年第11期604-609,共6页Journal of Clinical Emergency

基　　金：湖南省自然科学基金科卫联合项目(No:2022JJ70165)。

摘　　要：目的:心脏骤停(cardiac arrest,CA)患者复苏后特定时间段内暴露于高氧环境可能会加重脑缺血/再灌注损伤。本文主要研究高氧暴露对CA复苏后患者院内死亡率和神经功能预后的影响。方法:本研究利用MIMIC-IV数据库检索CA复苏后患者进行回顾性队列研究,根据设定的纳入排除标准,选择复苏后进行机械通气且存活72 h以上的病例进行研究。以复苏后72 h内有无发生动脉血氧分压(PaO_(2))≥200 mmHg(1 mmHg=0.133 kPa)为高氧暴露临界值分为高氧暴露组和非高氧暴露组。所有CA患者复苏后均采集动脉血气分析和进行神经功能评分,有完整的神经功能预后信息。通过统计两组患者的基线资料和相关临床数据,分析复苏后早期高氧暴露对临床预后结局的影响。结果:本研究共纳入了259例CA患者,高氧暴露组170例(65.6%)和非高氧暴露组89例(34.4%)。两组患者在年龄、性别、种族及既往患有高血压、恶心肿瘤、肺部疾病等基础疾病中差异无统计学意义(P>0.05)。与非高氧暴露组相比,高氧暴露组院内死亡率显著升高(P<0.05)。高氧暴露组患者复苏后72 h评估神经功能不良的占比明显高于非暴露组(P<0.05)。复苏后72 h内高氧暴露是CA复苏后患者院内死亡和神经功能预后不良的独立危险因素。其OR分别为2.1(95%CI:1.1~4.0)和2.2(95%CI:1.1~4.5)。结论:ROSC后72 h内发生高氧暴露是CA患者预后不良的独立危险因素,且高氧暴露选择的最佳临界点以PaO_(2)≥200 mmHg为宜。Objective:Exposure to hyperoxia for a specific duration following the resuscitation of cardiac arrest(CA) patients may exacerbate cerebral ischemia/reperfusion injury.This study investigates the impact of hyperoxia on in-hospital mortality and neurological outcomes in patients who have been resuscitated from cardiac arrest.Methods:A retrospective cohort study was conducted using data from the MIMIC-IV database.The study included post-resuscitation CA patients who were mechanically ventilated and survived for more than 72 hours,based on predefined inclusion and exclusion criteria.Patients were divided into two groups:hyperoxia-exposed and non-hyperoxia-exposed,with hyperoxia defined as partial pressure of arterial oxygen(PaO_2) ≥200 mmHg within 72 hours post-resuscitation.Arterial blood gas analysis and neurological function scores were collected for all patients with complete neurological prognostic information.The impact of early post-resuscitation hyperoxia on clinical outcomes was analyzed by comparing baseline characteristics and relevant clinical data between the two groups.Results:The study included 259 CA patients,with 170(65.6%) in the hyperoxia-exposed group and 89(34.4%) in the non-hyperoxia-exposed group.No statistically significant differences were observed between the groups in terms of age,gender,race,or pre-existing conditions such as hypertension,malignancies,and lung diseases(P>0.05).In-hospital mortality was significantly higher in the hyperoxia-exposed group compared to the non-hyperoxia-exposed group(P<0.05).Additionally,the percentage of patients with neurological dysfunction at 72 hours post-resuscitation was significantly greater in the hyperoxia-exposed group(P<0.05).Hyperoxia exposure within 72 hours after resuscitation was identified as an independent risk factor for in-hospital mortality and poor neurological prognosis,with odd ratio of 2.1(95%CI 1.1,4.0) and 2.2(95%CI 1.1,4.5) respectively.Conclusion:Hyperoxia exposure within 72 hours after the return of spontaneous circulation(ROSC)

关 键 词：心脏骤停 自主循环恢复 高氧血症 院内死亡率 神经损伤 动脉血氧分压 

分 类 号：R541.7[医药卫生—心血管疾病]