亚低温治疗心肺复苏患者pH值和乳酸动态变化与预后的关系研究  

The relationship between pH and lactic acid dynamic changes and prognosis in patients with cardiopulmonary resuscitation treated with mild hypothermia

作　　者：李光稳 石强 LI Guangwen;SHI Qiang(Department of Emergency,Nanping First Hospital Affiliated to Fujian Medical University,Nanping Fujian 353000,China)

机构地区：[1]福建医科大学附属南平第一医院急诊科,福建南平353000

出　　处：《中国急救复苏与灾害医学杂志》2024年第12期1541-1547,共7页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：福建省自然科学基金项目(编号:2021J011042)。

摘　　要：目的探究亚低温治疗的心肺复苏患者pH值和乳酸的动态变化与预后的关系。方法选取福建医科大学附属南平第一医院2018年5月—2023年5月收治的心脏骤停后心肺复苏成功救治的患者共103例作为研究对象,根据预后情况的不同,将患者分为预后良好组(38例)和预后不良组(65例),采用重复测量方差法分析两组亚低温治疗的心肺复苏患者pH值和乳酸水平的动态变化。采用Joint模型对pH值和乳酸水平与预后的关系进行分析,构建纵向波动多水平子模型(LME模型)和Cox生存子模型,通过关联系数将二者结合,同时对基线及随时间变化的纵向数据对生存危险函数的影响进行分析。采用多因素Logistics回归分析心肺复苏患者预后的影响因素,通过Logistic回归分析pH值和乳酸与患者预后的关系,并建立预测模型。采用受试者工作特征(ROC)曲线、ROC曲线下面积(AUC)估算模型的判别切点。结果(1)预后良好组和预后不良组在昏迷程度、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、机械通气时间、自主循环恢复时间、急诊危重病监护病房(EICU)入住时间、左心室射血分数(LVEF)、pH值、乳酸水平、12 h乳酸清除率、24 h乳酸清除率、血肌酐方面具有显著差异(P<0.05)。(2)重复测量方差分析结果显示,两组患者的pH值与乳酸水平的时间效应、组间效应和交互效应均具有统计学意义(P<0.001)。单因素重复测量方差分析结果显示:与治疗前比较,两组患者治疗后的pH值均呈显著上升趋势(P<0.001);乳酸水平均呈显著下降趋势(P<0.001)。多变量方差分析结果显示:预后不良组治疗后12、24、72 h的pH值均低于预后良好组,乳酸水平均高于预后良好组(P<0.001)。(3)Joint模型分析结果显示,pH值每降低0.1,预后不良风险增加5%(P<0.01);乳酸水平每升高1 mmol/L,预后不良风险增加4%(P<0.01)。(4)多因素Logistic回归分析表明,自主循�Objective To explore the relationship between the dynamic changes of pH and lactic acid and prognosis in patients with cardiopulmonary resuscitation(CPR)treated with mild hypothermia.Methods A total of 103 patients who were successfully treated with cardiopulmonary resuscitation after cardiac arrest in our hospital from May 2018 to May 2023 were selected as the study objects.According to the different prognosis,the patients were divided into a good prognosis group(38 cases)and a poor prognosis group(65 cases).The dynamic changes of pH and lactic acid levels in mild hypothermia cardiopulmonary resuscitation patients were analyzed and compared by repeated measurement variance method.The Joint model was used to analyze the relationship between pH value and lactic acid level and the prognosis of cardiopulmonary resuscitation patients treated with mild hypothermia.The longitudinal fluctuation multilevel submodel(LME model)and Cox survival submodel were constructed,and the two were combined by association coefficient.At the same time,the impact of baseline and longitudinal data over time on survival risk function was analyzed.Multi-factor Logistics regression was used to analyze the factors affecting the prognosis of patients with cardiopulmonary resuscitation,and the relationship between pH value and lactic acid and the prognosis of patients with cardiopulmonary resuscitation treated with mild hypothermia was analyzed by Logistic regression,and a prediction model was established.Receiver operating characteristic curve(ROC)and area under ROC curve(AUC)were used to estimate the discriminant tangent points of the model.Results(1)Coma degree,APACHEⅡscore,mechanical ventilation time,recovery time of spontaneous circulation,time of admission to emergency critical care unit(EICU),left ventricular ejection fraction(LVEF),pH value,lactic acid level,12 hours lactic acid clearance rate,24 hours lactic acid clearance and serum creatinine were significantly different(P<0.05).(2)The results of repeated measurement ANOVA showed th

关 键 词：心肺复苏 亚低温治疗 PH值 乳酸 预后 

分 类 号：R541[医药卫生—心血管疾病] R605.974[医药卫生—内科学]