建立心肺复苏自主循环恢复昏迷患者预后评分法的探讨

To set up the prognostic scores system in comatose survivors with the return of spontaneous circulation after cardiopulmonary resuscitation

目的建立心肺复苏（CPR）自主循环恢复（ROSC）昏迷患者预后的预测方法，验证其对患者不同预后类型的分辨能力。方法分析文献，找出CPR自主循环恢复昏迷患者预后的相关因素，赋予每个因素一定分值，引入急性生理和慢性健康状况评分Ⅱ（APACHEⅡ），建立CPR自主循环恢复预后评分法。用该评分法回顾评价115例CPR自主循环恢复住院患者的预后，比较不同预后患者CPR自主循环恢复的预后评分，计算其对严重不良预后（死亡或植物状态）和其他类型预后分辨能力的ROC曲线下面积。结果患者5种不同预后（正常、轻度神经功能障碍、重度神经功能障碍、植物状态和死亡）CPR自主循环恢复预后评分比较差异有统计学意义（F=79．97，P=0．000）。各组组间比较：正常组与轻度神经功能障碍组比较差异无统计学意义（P=0．092）；其他各组相互比较差异均有统计学意义（轻度神经功能障碍组vs重度神经功能障碍组P=0．041，重度神经功能障碍组vs植物状态组P=0．006，其他各组比较均P=0．000）。CPR自主循环恢复预后评分对严重不良预后与其他类型预后分辨能力的表现：在评分为22．5分时，灵敏度100．0％，特异度78．6％，诊断指数178．6；在评分为32．5分时，灵敏度77．8％，特异度98．6％，诊断指数176．4。23分和33分是两个关键截断点。CPR自主循环恢复预后评分对严重不良预后分辨能力的ROC曲线下面积为0．968。结论CPR自主循环恢复预后评分可以准确预测CPR自主循环恢复昏迷患者的最终预后，对预后严重不良和预后良好具有较强的分辨能力。

Objective To set up the prognostic scores system in comatose survivors with return of spontaneous circulation after cardiopulmonary resuscitation （CPR） and evaluate its performance. Methods Variables of the prognosis were identified by systematically reviewing published literature on the resuscitation. A value was assigned to these variables. We used these variables in combination with APACHE II score to devise a multifactorial prediction score system - Prognostication Score （ PRCSs - PS ）. Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed by using PRCSs- PS. Score of patients with different outcomes was compared. The area under the receiver - operating characteristic （ ROC） cure was determined to evaluate the performance of this tool to identify the patients with a poor outcome （ CPC 4 and 5 ） ☆ and other outcomes （ CPC1, 2 and 3 ） . Result There were differences among the groups with five different outcomes （ CPC1 - 5 ） （ F = 79. 97, P = 0. 000 ）. Pairwise groups with different CPC were compared： no significant difference was found between CPCI and CPC2 （P = 0.092 ） , but difference between other pairwise CPC groups was statistically significant （CPC2 VS CPC3, P = 0.041 ; CPC3 VS CPC4 ： P = 0. 006 ; others, P = 0. 000 ）. The performance of PRCSs - PS to discriminate between the patients with a poor outcome and patients with other outcomes was as follows： it had 100% sensitivity, 78.6% specificity, and 178.6 diagnostic index at the score cut - off 22.5 ; it had 77.8% sensitivity, 98.6% specificity and 176.4 diagnostic index at the score cut -off 32.5. Score 23 and 33 were two key cut - off points. The area under the ROC cure was 0.968, which showed excellent discrimination. Conclusions The final outcomes in post - resuscitation comatose survivors can be accu- rately predicted by using PRCSs Prognostication Score. PRCSs Prognostication Score is more capable of identifying patients with a poor and a favorable outcome. ☆： The Glasgow - Pittsburgh Cerebral Performance Categories （ CPC ） feature a 5 - point scale ： CPC 1 - good cerebral performance, CPC 2 - moderate cerebral disability, CPC 3 - severe cerebral disability, CPC 4 - vegtative state, and CPC 5 - death.