心肺复苏后多器官功能障碍综合征的临床分析

Clinical analysis of multiple organ dysfunction syndrome after cardiopulmonary resuscitation

目的 提高对心搏骤停复苏后发生多器官功能障碍综合征相关临床特点的认识,为其综合防治提供依据.方法 采用回顾性分析方法,收集吉林大学第二医院ICU收治的72例心搏骤停自主循环恢复患者的相关临床资料,主要包括心搏骤停地点、心搏骤停首次监测到的心律类型,心搏骤停原因,全身炎症反应综合征（SIRS）和多器官功能障碍综合征（MOOS）发生率,发生器官功能障碍的部位及个数,复苏成功率,存活出院率以及出院时脑功能分类评分（CPC）.结果 心搏骤停自主循环恢复（ROSC）患者男女比例为1.18：1,院内和院外分别为55例和17例,比例为3.24：1.心搏骤停地点分布：院内以ICU、急诊室和手术室为主,共计41例,占74.55%（41/55）;院外以来院途中和救护车中为主,共计11例,占64.71%（11/17）.心搏骤停首次监测到的心律类型中可电击心律和非电击心律分别为38例和32例,比例为1.12：1;心搏骤停原因中心脏源性和非心脏源性因素分别为37例和35例,比例为1.06：1.72例心搏骤停ROSC患者中16例在24 h内死亡,56例心肺复苏成功,但其中51例在自主循环恢复后发生SIRS,42例相继合并NODS占75%（42/56）,死亡27例占64.29%（27/42）;受累器官依次为：脑38例（90.48%）,心35例（83.33%）,肺28例（66.67%）.在56例心肺复苏成功患者中,MODS（-）组14例全部存活出院,MODS（＋）组42例中存活15例,共计存活出院率为40.28%（29/72）.MODS（-）组14例全部为CPC 1分,MODS（＋）组CPC 1～2分7例、CPC 3～5分35例.两组患者性别和年龄比较差异无统计学意义（P〉0.05）,而脑功能分类评分和存活出院率比较差异均有统计学意义（P〈0.01）.结论 心搏骤停患者在自主循环恢复后SIRS发生较为普遍,随之合并MODS的发生率高,且心脑功能障碍位居受累器官前列,复苏后多器官功能障碍综合征是影响心搏骤停患者预后的重要因素.

Objective To enhance the cognition on the clinical features of post resuscitation multiple organ dysfunction syndrome （PR-MODS） in patients after cardiac arrest, and provide the basis for integrated control. Method Based on the retrospective analysis, the clinical data of 72 patients with cardiac arrest with restoration of spontaneous circulation （ROSC） in ICU were collected, including happening place of cardiac arrest, the type of rhythm first monitored after cardiac arrest, cause of cardiac arrest, incidence of SIRS and MODS, the position and number of organ dysfunction, success rate of CPR, the rate of survival to hospital discharge and cerebral performance categories（CPC） of discharged patients. Results ①In patients with ROSC after cardiac arrest, male to female ratio was 1.18：1,55 cases was happened in hospital and 17 cases was happened out of hospital, and the ratio was 3.24：1. ②The distribution of cardiac arrest place： ICU,emergency room and operating room were the major places of in-hospital cardiac arrest, adding up to 41 cases and accounting for 74.55% （41/55）; the major places of outhospital cardiac arrest were on the way to hospital and in the ambulance, and accounting for 64.71% （11/ 17）. ③According to the rhythm first monitored after cardiac arrest, there were 38 cases using shock and 32 cases using non-shock, the ratio was 1.12： 1. Cardiac arrest causes of cardiogenic and on-cardiogenic factors are 37 cases and 35 cases, a ratio of 1.06：1 .④All of the 72 cases, 16 cases died within 24 h, and 56 cases were successfully resuscitated, but 51 cases occurred SIRS after ROSC, 42 cases had combined MODS （42/56,75%）, 27 cases（27/42,64.29%）died.The most involving organs in sequence were brain （38 cases, 90.48%）, heart （35 cases,83.33%） and lung （28 cases, 66.67%）. ⑤Among the 56 successfully resuscitated patients, MODS （ - ） group （14 cases） all survived, 15 cases in MODS （ ＋ ） group （42 cases） survived, a total rate of survived to hospital discharge was 40.28%（29/72）. All the MODS （ - ） group （ 14 cases） got CPC 1 point. In MODS （ ＋ ） group, there were 7 cases getting CPC 1-2 point, 35 cases getting CPC 3-5 point. There were no significant difference between sex and age in the two groups （P 〉 0.05）, while the comparison of CPC and survived to hospital discharge rate had statistically significance （P 〈 0.001）. Conclusions The occurrence of SIRS in cardiac arrest patients with ROSC was common and there was high incidence of MODS subsequently. The heart and brain were the mostly involved dysfunctional organs. PR-MODS was an important factor influencing the prognosis of patients with cardiac arrest.