心脏骤停自主循环恢复后昏迷患者血管内目标温度管理启动时机对院内生存率及神经功能预后的回顾性分析  

Retrospective analysis of the timing of intravascular target temperature management activation on in-hospital survival rate and neurological prognosis in comatose patients of return of spontaneous circulation from cardiac arrest

作　　者：聂晓雪 杨秀婷 刘海雁 田双颖 边圆[1] 徐峰[1] NIE Xiaoxue;YANG Xiuting;LIU Haiyan;TIAN Shuangying;BIAN Yuan;XU Feng(Department of Emergency,Qilu Hospital,Shandong University,Jinan,250012,China)

机构地区：[1]山东大学齐鲁医院急诊科,济南250012

出　　处：《临床急诊杂志》2025年第3期183-188,共6页Journal of Clinical Emergency

基　　金：山东省重点研发计划(No:2024CXPT089);山东省重点研发计划(重大科技创新项目)(No:2022CXGC010504)。

摘　　要：目的:探讨心脏骤停自主循环恢复(return of spontaneous circulation,ROSC)后昏迷患者血管内目标温度管理(targeted temperature management,TTM)启动时机及其对院内生存率及神经功能预后的影响。方法:纳入2020年8月—2024年10月我院重症监护病房心脏骤停ROSC持续20 min以上并接受血管内降温的昏迷患者,按照不同的TTM上机时间进行分组,1组为心脏骤停ROSC后至TTM时间≤8 h,2组为心脏骤停ROSC后至TTM时间8~16 h,3组为心脏骤停ROSC后至TTM时间16~24 h,4组为心脏骤停ROSC后至TTM时间>24 h。对不同分组患者从出院生存率和良好的神经功能预后率方面进行比较,对结局事件进行多因素logistic回归分析。结果:根据纳入和排除标准,共纳入104例患者,1组的生存率明显高于其他3组,差异有统计学意义(P<0.05);1组的神经功能良好预后率高于其他3组,但差异无统计学意义(P>0.05)。对结局事件进行多因素logistic回归分析发现,与TTM上机时间不大于8 h组比较,大于8 h组有更高的死亡率(OR=4.470,95%CI 1.260~15.856,P<0.05),提示提前血管内TTM上机时间可能改善心脏骤停患者的生存;与TTM上机时间不大于8 h组比较,大于8 h组神经功能预后不良的比率更高(OR=5.395,95%CI 1.321~22.042,P<0.05),提示血管内TTM上机时间延迟是心脏骤停患者院内神经功能预后不良的独立危险因素。结论:在心脏骤停ROSC后昏迷患者中,8 h内尽早行血管内TTM对出院生存率及良好的神经功能预后有益,需进一步开展大规模临床对照试验研究。Objective To explore the specific timing of intravascular target temperature management(TTM)activation and its impact on in-hospital survival rate and neurological prognosis in comatose patients of return of spontaneous circulation from cardiac arrest.Methods This study included comatose patients in the intensive care unit of our hospital,who had been recovering from spontaneous circulation for more than 20 minutes and receiving intravascular cooling from August 2020 to October 2024.They were divided into four groups according to different TTM operating times:Group 1 had a TTM time of≤8 hours after returning of spontaneous circulation after cardiac arrest,Group 2 had a TTM time of 8-16 hours after returning of spontaneous circulation after cardiac arrest,Group 3 had a TTM time of 16-24 hours after returning of spontaneous circulation after cardiac arrest,and Group 4 had a TTM time of>24 hours after returning of spontaneous circulation after cardiac arrest.The discharge survival rate and good neurological prognosis of patients in different groups were compared.The multiple logistic regression on the outcome event was performed.Results According to the inclusion and exclusion criteria,a total of 104 patients were included.The survival rate of Group 1 was significantly higher than those of the other three groups,and the difference was statistically significant(P<0.05).The good neurological prognosis rate of Group 1 was higher than those of the other three groups,but the difference was not statistically significant(P>0.05).After conducting multiple logistic regression analysis on the outcome events,it was found that compared with the group with TTM machine time not exceeding 8 hours,the group with TTM machine time exceeding 8 hours had a higher mortality(OR=4.470,95%CI 1.260-15.856,P<0.05).Advancing the intravascular TTM machine time may improve the survival of patients with cardiac arrest.Compared with the group with TTM operation time not exceeding 8 hours,the group with TTM operation time exceeding 8 hours had a

关 键 词：心脏骤停 自主循环恢复 目标温度管理 院内生存率 神经功能预后 

分 类 号：R541[医药卫生—心血管疾病]