心搏骤停后综合征患者应用心肺复苏后GCS评分与APACHE Ⅱ评分评估神经功能预后的临床价值比较

The application comparison of GCS score and APACHE Ⅱ score after cardiopulmonary resuscitation in predicting prognosis neural function in patients with post-cardiac arrest syndrome

目的:比较心肺复苏后格拉斯哥昏迷量表(GCS)评分与急性生理与慢性健康评价Ⅱ(APACHEⅡ)评分在评价心搏骤停后综合征患者神经功能预后中的应用价值差异。方法:选取2014-01—2017-01期间我院重症医学科收治的心搏骤停后综合征患者128例,根据心肺复苏后90d格拉斯哥-匹兹堡脑功能表现分类(CPC)评分将患者分为神经功能预后良好组(n=50)与神经功能预后不良组(n=78)。比较两组机械通气时间、心肺复苏时间、GCS评分与APACHEⅡ评分等临床指标的差异,并采用受试者工作特征曲线(ROC)分析GCS评分与APACHEⅡ评分对神经功能预后的预测价值差异。结果:神经功能预后良好组机械通气时间与心肺复苏时间明显短于神经功能预后不良组,GCS评分明显高于神经功能预后不良组,APACHEⅡ评分明显低于神经功能预后不良组(均P<0.05)。心肺复苏后,经Pearson相关性分析显示,GCS评分与APACHEⅡ评分之间存在直线负相关(r=-0.521,P<0.05);GCS评分对心搏骤停后综合征患者神经功能预后的预测价值(0.905)明显高于A PACHEⅡ评分(0.751),差异有统计学意义(P<0.05)。结论:心肺复苏后GCS评分在评价心搏骤停后综合征患者神经功能预后的应用价值明显优于APACHEⅡ评分,可作为理想的评价指标。

Objective：To compare the application value difference of Glasgow coma scale（GCS）score and Acute physiology and chronic health evaluation（APACHEⅡ）score after cardiopulmonary resuscitation in predicting prognosis neural function in patients with post-cardiac arrest syndrome.Method：One hundred and twenty-eight cases of patients with post-cardiac arrest syndrome from ICU of our hospital during the period of January 2014 and January 2017 were selected,the patients were divided into good neural function prognosis group（n=50）and worse neural functional prognosis group（n=78）according to cerebral performance category（CPC）score after cardiopulmonary resuscitation 90 d.The differences of clinical indexes as mechanical ventilation time,cardiopulmonary resuscitation time,GCS score and APACHEⅡscore between the two groups were compared,and the differences of neural function prognosis prediction value between GCS score and APACHEⅡscore were analyzed by receiver operating characteristic curve（ROC）curve.Result：The mechanical ventilation time and cardiopulmonary resuscitation time of good neural function prognosis group were obviously shorter than worse neural functional prognosis group,GCS score was significantly higher and APACHEⅡscores was significantly lower than worse neural functional prognosis group（P〈0.05）.After cardiopulmonary resuscitation,Pearson correlation analysis showed that it had linear negative correlation between GCS score and APACHEⅡscore（r=-0.521,P〈0.05）,neural function prognosis prediction value in prognosis neural function of GCS score（0.905）was obviously higher than that of APACHEⅡscore（0.751）（P〈0.05）.Conclusion：The application value of GCS score after cardiopulmonary resuscitation in predicting prognosis neural function is better than APACHEⅡ score in patients with post-cardiac arrest syndrome,and can be used as ideal predictor.