不同昏迷评估方法判定心肺复苏成功患者预后的价值

Value of coma evaluating approaches in predicting prognosis of patients after cardiopulmonary resuscitation

目的探讨昏迷的客观评估方法和主观评估方法判定心脏骤停后心肺复苏成功患者预后的价值。方法选择心脏骤停后心肺复苏成功的昏迷患者39例,复苏后24 h内行脑电双频指数(BIS)监测,同时进行格拉斯哥昏迷量表(GCS)评分和GCS-Pittsburgh评分,观察其6个月时的预后,并分析不同评估方法判定预后的价值。结果 6个月后,预后良好11例,预后不良28例。三种评估方法的预后不良组分值均明显低于预后良好组(P均<0.05);患者运动反应、对光反射、脑干反射及自主呼吸消失判断预后不良的敏感性均为100%,其中脑干反射的敏感性和特异性均较高;BIS监测判断预后不良的特异性、阳性预测值和准确性显著高于GCS-Pittsburgh评分(P<0.05)。结论三种昏迷评估方法均可判定心肺复苏后昏迷患者预后,但客观评估方法 BIS监测对预后不良的判定价值优于主观评估方法。

Objective To determine the value of the objective bispectral index （BIS） and the subjective GCS and GCS-Pittsburgh score in evaluating the prognosis of comatose patients after cardiopulmonary resuscitation （CPR） because of cardiac arrest. Methods A total of 39 comatose patients after successful CPR because of cardiac arrest were included. BIS, GCS and GCS-Pittsburgh value were recorded within 24 hours after CPR, then to observe the prognosis for six months, analyze and evaluate the value of different approachs in predicting prognosis. Results After six months, 11 cases were in bad-prognosis group, 28 cases in good-prognosis group. The evaluation values of bad-prognosis group were lower than those of good-prognosis group （P 〈 0.05）. The sensitivity of vanish of motor reaction, light reflex, brainstem reflex and sponta- neously breathing were 100% to predict bad-prognosis. The sensitivity and specificity of brainstem reflex were both high. The specificity, positive predictive and accuracy values of BIS were higher than those of GCS-Pittsburgh score significantly in predicting bad-prognosis of patients after CPR （P 〈 0.05）. Conclusions BIS, GCS and GCS-Pittsburgh score corre- lates to the prognosis of comatose patients after CPR. The objective evaluating approach bispectral index （BIS） surpasses the subjective approaches in evaluating unfavourable prognosis.