心脏骤停患者PetCO_(2)和CO监测及其对心肺复苏结局的预测价值  

Monitoring of PETCO_(2)and CO levels in patients with cardiac arrest and their value in assessing resuscitation outcomes

作　　者：于美军 王秋艳 王晓蕾 陈静[2] 曾君 李力平 吴双 Yu Meijun;Wang Qiuyan;Wang Xiaolei(Department of Critical Care Medicine,Peking University Third Hospital Qinhuangdao Hospital,Qinhuangdao 066000,China)

机构地区：[1]北京大学第三医院秦皇岛医院重症医学科,秦皇岛066000 [2]北京大学第三医院秦皇岛医院急诊科,秦皇岛066000

出　　处：《中华保健医学杂志》2025年第1期68-71,共4页Chinese Journal of Health Care and Medicine

基　　金：秦皇岛科技计划项目(202301A083)。

摘　　要：目的探讨呼气末二氧化碳分压(PetCO_(2))与心脏骤停患者心输出量(CO)的关系及其对心肺复苏结局的预测价值。方法前瞻性选取2021年10月~2023年10月于北京大学第三医院秦皇岛医院急诊及重症医学科就诊的107例心脏骤停患者,根据自主循环恢复(ROSC)情况分为ROSC组(n=90)和非ROSC组(n=17);根据心肺复苏是否成功分为成功组(n=100)和失败组(n=7)。分别比较ROSC组与非ROSC组、心肺复苏成功组与失败组患者在不同时间段(心肺复苏开始、复苏10 min、复苏20 min、复苏30 min、复苏6 h)的PetCO_(2)和CO,分析PetCO_(2)与CO的相关性,采用受试者工作特征(ROC)曲线分析PetCO_(2)和CO对心肺复苏失败的预测效能。结果ROSC组患者在复苏10 min、复苏20 min、复苏30 min、复苏6 h时的PetCO_(2)、CO均高于非ROSC组患者,差异均有统计学意义(t=3.080,2.758,7.236,4.361,5.395,11.662,7.978,4.827,P<0.05)。在复苏10 min、复苏20 min、复苏30 min以及复苏6 h时,心肺复苏成功组患者的PetCO_(2)、CO水平均高于心肺复苏失败组患者,差异均有统计学意义(t=3.843,2.744,5.005,4.147,5.395,11.662,2.948,2.454,P<0.05)。Pearson相关性分析结果显示,PetCO_(2)与CO均呈正相关(r=0.392,P<0.01)。PetCO_(2)联合CO预测心脏骤停患者心肺复苏失败的AUC为0.906,95%CI=0.859~0.952,灵敏度为95.12%,特异度为92.28%,均高于二者单独检测。结论心脏骤停患者的PetCO_(2)与CO存在一定的相关性,二者联合监测可提高对心肺复苏结局的预测效能,具有一定的参考价值。Objective To analyze the relationship between end-expiratory partial pressure of carbon dioxide(PetCO_(2))and cardiac output in patients with cardiac arrest and its predictive value for the outcome of cardiopulmonary resuscitation.Methods A prospective study was conducted on 107 patients with cardiac arrest admitted to the Department of Emergency and Critical Care(ICU)of Qinhuangdao Hospital,Peking University Third Hospital from October 2021 to October 2023.Patients were divided into the ROSC group(n=90)and non-ROSC group(n=17)according to the return of spontaneous circulation(ROSC)situation,and also into the successful cardiopulmonary resuscitation group(n=100)and the failed group(n=7)based on the success of cardiopulmonary resuscitation.PetCO_(2)and cardiac output(CO)were compared between the ROSC group and non-ROSC group,and between the successful and failed cardiopulmonary resuscitation groups at different time periods(beginning of cardiopulmonary resuscitation,10-min resuscitation,20-min resuscitation,30-min resuscitation,6-h resuscitation).Pearson correlation analysis was performed to analyze the correlation between PetCO_(2)and CO,and the receiver-operating characteristic(ROC)curve was plotted to analyze the predictive efficacy of PetCO_(2)and CO on cardiopulmonary resuscitation failure.Results At 10-min,20-min,30-min,and 6-h resuscitation,the PetCO_(2)and CO levels in the ROSC group were significantly higher than those in the non-ROSC group(t=3.080,2.758,7.236,4.361,5.395,11.662,7.978 and 4.827,respectively;P<0.05).At 10-min,20-min,30-min,and 6-h resuscitation,the PetCO_(2)and CO levels in the successful cardiopulmonary resuscitation group were significantly higher than those in the failed group(t=3.843,2.744,5.005,4.147,5.395,11.662,2.948,2.454,respectively;P<0.05).PetCO_(2)and CO were positively correlated(r=0.392,P<0.01).The AUC of PetCO_(2)and CO combined monitoring to predict cardiopulmonary resuscitation failure was 0.906,and the 95%CI confidence interval was 0.859~0.952.The sensitivity(95.12%)and s

关 键 词：呼气末二氧化碳分压 心脏骤停 心输出量 心肺复苏 结局 

分 类 号：R541[医药卫生—心血管疾病]