心肺复苏自主循环恢复患者预后预测的多因素分析

Multivariate analysis of prognosis in cardiopulmonary resuscitation after return of spontaneous circulation recovery

目的确定预测心肺复苏自主循环恢复昏迷患者预后的指标。方法心肺复苏自主循环恢复昏迷患者213例,对其可能与预后相关的指标分别进行单因素分析和多因素分析。结果年龄、基础疾病、心脏骤停场所不能预测患者预后,复苏开始时间、复苏持续时间、心跳骤停前的心律、复苏中有无室颤或室速、复苏后第3天的APACHEⅡ评分、复苏后有无肌阵挛或抽搐、有无脑干反射等在一定程度上预测患者的预后。这些因素对患者预后的预测价值排序分别为:脑干反射>肌阵挛或抽搐>复苏开始时间>心跳骤停前的心律>APACHEⅡ评分>复苏中有无室颤或室速>复苏持续时间。结论有无脑干反射、有无肌阵挛或抽搐、复苏开始时间、心跳骤停前的心律、复苏后第3天的APACHEⅡ评分、复苏中有无室颤或室速、复苏持续时间等指标是建立心肺复苏自主循环恢复昏迷患者预后预测系统的基本指标。

Objective To explore the prediction factors of evaluate the prognosis in cardiopulmonary resuscitation （CPR） after return of spontaneous circulation（ROSC）.Methods Totally 213 patients with CPR after ROSC were enrolled in study and clinic data were collected.The factors which possibly predict outcomes of CPR after ROSC were analyzed by single factor analysis and multivariate analysis respectively.Results The age,basic disease,site of cardiac arrest couldn＇t predict the outcome of patients with CPR after ROSC;but the arrest times,rescuing times, rhythm of the heart before arrest and during rescue cause,APACHEⅡscore,hyperspasmia or myoclonus and neural reflex of brainstem after 3 days could predict the outcome.The value sort order of prediction factors from maximum to minimum were neural reflex of brainstem,hyperspasmia or myoclonus,arrest times,rhythm of the heart before arrest, APACHEⅡscore,rhythm of the heart during rescue cause and rescuing times.Conclusion The neural reflex of brainstem and cerebral cortex functions after 3 days of CPR had the superem veracity for predict the outcome of patients with CPR after ROSC.The following factors include neural reflex of brainstem,hyperspasmia or myoclonus,arrest times,rhythm of the heart before arrest,APACHEⅡscore,rhythm of the heart during rescue cause and rescuing times may be the basic factors which used to build up outcome prediction system for patients with CPR after ROSC.