心脏骤停复苏后患者短期死亡及神经功能预后的危险因素分析  

Analysis of risk factors for short-term mortality and neurological prognosis in patients after cardiac arrest resuscitation

作　　者：李雪昕 闫圣涛[1] LI Xuexin;YAN Shengtao(Department of Emergency,China-Japan Friendship Hospital,Beijing,100089,China)

机构地区：[1]中日友好医院急诊科,北京100089

出　　处：《临床急诊杂志》2025年第3期175-182,共8页Journal of Clinical Emergency

基　　金：中日友好医院高水平医院临床业务费专项临床研究项目(No:2022-NHLHCRF-YS-03)。

摘　　要：目的:探讨心脏骤停复苏后患者入院时临床指标对短期死亡率及神经功能预后的预测作用,为高危患者的早期识别与干预提供依据。方法:本研究为回顾性队列研究,纳入2022年1月—2024年9月入住急诊重症监护室的47例心脏骤停复苏后自主循环恢复患者。收集患者的基础资料、心脏骤停情况、实验室检查结果及病情评估数据,通过单因素和多因素logistic回归分析评估各指标对7 d和30 d死亡率及脑功能状态评分(CPC)的影响,并采用受试者工作特征曲线分析关键指标的预测价值。结果:患者入院时的病情严重程度评分(APACHEⅡ、SOFA)及神经功能评分是短期死亡和神经功能预后的显著影响因素(P<0.05)。格拉斯哥昏迷评分(GCS)为7 d和30 d死亡率及CPC评分的独立预测指标(P<0.05),GCS评分每增加1分,7 d死亡风险下降38.4%,30 d死亡风险下降32.7%。受试者工作特征曲线分析表明,GCS评分预测患者7 d死亡、30 d死亡和CPC评分3~5级的曲线下面积分别为0.793、0.894和0.892,最佳截断值分别为4、4和7分。GCS评分较高的患者短期存活率及神经功能恢复良好的比例显著提高(P<0.05)。结论:入院时病情评估和神经功能评分是心脏骤停复苏后患者短期死亡率及神经功能预后评估的重要指标,早期评估有助于更精准地识别高危患者并制定个体化治疗策略,从而提高患者的存活率和神经功能恢复的可能性。Objective To investigate the predictive value of clinical indicators at admission for on short-term mortality and neurological prognosis in patients admitted after cardiac arrest resuscitation,and to provide a basis for early identification and intervention in high-risk patients.Methods This was a retrospective cohort study that included 47 patients with return of spontaneous circulation after resuscitation from cardiac arrest who were admitted to the Emergency Intensive Care Unit between January 2022 and September 2024.The patients'basic information,cardiac arrest conditions,laboratory findings and condition assessment data were collected,and the effects of each indicator on 7-and 30-day mortality and Cerebral Performance Category(CPC)were assessed through univariate and multivariate logistic regression analyses.The predictive value of key indicators was analyzed using receiver operating characteristic curves.Results The severity of illness scores(APACHEⅡ,SOFA)and neurological function scores at admission were significant influencing factors on short-term mortality and neurological prognosis(P<0.05).The Glasgow Coma Scale(GCS)score was an independent predictor of 7-and 30-day mortality,as well as CPC score(P<0.05).For every 1 point increase in GCS score,the risk of 7-day mortality decreased by 38.4%,and the risk of 30-day mortality decreased by 32.7%.The receiver operating characteristic curve showed that the area under the curve of the GCS score predicting 7-day death,30-day death and CPC score grades 3-5 were 0.793,0.894 and 0.892,respectively,with optimal cut-off values of 4,4 and 7 scores.The short-term survival rate and the proportion of patients with good neurological recovery were significantly higher in patients with higher scores of the GCS(P<0.05).Conclusion Condition assessment and neurological function score at admission are important indicators for short-term mortality and neurological prognosis assessment of patients after resuscitation from cardiac arrest.Early assessment helps to identify high-

关 键 词：心脏骤停 自主循环恢复 短期死亡率 神经功能评价 格拉斯哥昏迷评分 

分 类 号：R541[医药卫生—心血管疾病]