院外心搏骤停心肺复苏后患者院前转运过程中应激性血糖升高及呼气末二氧化碳分压对预后的影响  

Influence of stress blood glucose and partial pressure of end-expiratory carbon dioxide on prognosis in patients with cardiopulmonary resuscitation after out-of-hospital cardiac arrest

作　　者：卢栋 孙玉莲 Lu Dong;Sun Yulian(Department of Emergency,Wuxi Emergency Center,Wuxi 214000,Jiangsu,China;Department of Clinical Laboratory,Huishan District People's Hospital,Wuxi 214000,Jiangsu,China)

机构地区：[1]无锡市急救中心急救科,江苏无锡易214000 [2]无锡市惠山区人民医院检验科,江苏无锡214000

出　　处：《中国中西医结合急救杂志》2024年第5期544-548,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨院外心搏骤停(OHCA)心肺复苏(CPR)后患者院前转运过程中应激性血糖升高及呼气末二氧化碳分压(P_(ET)CO_(2))对预后的预测价值。方法选取2021年1月至2023年11月无锡市急救中心收治的221例CPR成功后OHCA患者作为研究对象,按患者入院28d内预后情况,将死亡、呼吸心跳恢复但意识未恢复的患者纳入预后不良组,其余纳入预后良好组。收集患者临床资料,包括性别、年龄、体质量指数(BMI)基础疾病(高血压、糖尿病、高脂血症、冠心病)、吸烟史、饮酒史、脑血管病史、CPR持续时间、OHCA原因(心源性、非心源性),入住重症监护病房(ICU)第1天急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、格拉斯哥昏迷评分(GCS)呼吸频率(RR)、心率、平均动脉压(MAP)、体温、白细胞计数(WBC)、红细胞计数(RBC)、血小板计数(PLT)、血乳酸(Lac)降钙素原(PCT)、C-反应蛋白(CRP)、血清丙氨酸转氨酶(ALT)天冬氨酸转氨酶(AST)、尿素氮(BUN)、血肌酐(SCr)纤维蛋白原(Fib)、D-二聚体、肾上腺素用量、有无亚低温治疗、机械通气时间、ICU停留时间、应激性血糖升高比值(SHR)、P_(ET)CO_(2)等,比较不同预后两组临床资料的差异。采用Logistic回归模型分析影响CPR成功后OHCA患者近期预后的因素;采用受试者工作特征曲线(ROC曲线)评估各影响因素对患者预后的预测效能。结果最终纳入221例CPR成功后OHCA患者,40例预后良好,181例预后不良。预后不良组SHR、APACHEⅡ评分、SOFA评分、LaC、肾上腺素用量>5mg比例、ICU停留时间均明显高于预后良好组[SHR:1.19±0.14比1.02±0.09,APACHEⅡ评分(分):23.01±3.15比17.01±2.41,S0FA评分(分):8.62±1.09比6.32±0.98,Lac(mmol/L):10.32±1.69比7.01±1.02,肾上腺素用量>5mg比例:67.96%(123/181)比45.00%(18/40),ICU停留时间(d):8.59±1.42比8.01±1.53,均P<0.05],P_(ET)CO_(2)和GCS评分均明显低于预后良好组[P_(ET)CO_(Objective To investigate the predictive value of stress glucose elevation and partial pressure of end-expiratory carbon dioxide(P_(ET)CO_(2))on the prognosis of patients after out-of-hospital cardiac arrest(OHCA)and cardiopulmonary resuscitation(CPR).Methods A total of 221 patients with OHCA after successful CPR admitted to Wuxi Emergency Center from January 2021 to November 2023 were selected as the study subjects.Based on their 28-day prognosis,patients who died or achieved respiratory and heartbeat recovery without regaining consciousness were classified into the poor prognosis group,while the remaining patients were categorized into the good prognosis group.Clinical data were collected,including gender,age,body mass index(BMI),underlying diseases(hypertension.diabetes,hyperlipidemia,coronary heart disease),smoking history,alcohol history,cerebrovascular history,CPR duration,OHCA causes(cardiogenic,non-cardiogenic),acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),Glasgow coma scale(GCS),respiratory rate(RR),heart rate,mean arterial pressure(MAP),body temperature,white blood cell count(WBC),red blood cell count(RBC),platelet count(PLT).blood lactate(Lac),procalcitonin(PCT),C-reactive protein(CRP),serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea nitrogen(BUN),serum creatinine(SCr),fibrinogen(Fib),D-dimer and epinephrine dose,presence or absence of hypothermia therapy,duration of mechanical ventilation,ICU stay time and stress glucose elevation ratio(SHR),P_(ET)CO_(2),etc.,and the differences in clinical data between the two groups were compared.The Logistic regression model was used to analyze the factors affecting the short-term prognosis of OHCA patients after successful CPR,and the receiver operator characteristic curve(ROC curve)was used to evaluate the predictive performance of each influencing factor on the prognosis of patients.Results Finally,221 patients with OHCA after successful CPR were included,40 had a good prognosis and

关 键 词：院外心搏骤停 心肺复苏 应激性血糖升高 呼气末二氧化碳分压 预后 

分 类 号：R54[医药卫生—心血管疾病]