心脏骤停后综合征患者早期目标治疗情况调研

Investigation on the quality of management for the patients suffered with post cardiac arrest syndrome

目的分析心肺复苏（CPR）后实施亚低温治疗患者72h内平均动脉压（MAP）、氧分压（PaO2）、二氧化碳分压（PaCO2）、血糖（BG）和核心体温（TC）的达标情况，评价心脏骤停后综合征（PCAS）患者管理质量的优劣。方法采用回顾性资料对照研究的方法，观察在2005-0l-01—2010—12—31期间入住我院重症医学科（ICU）心肺复苏后并实施亚低温治疗的患者。收集人住ICU最初72h主要目标治疗指标（MAP、Pa02、PaCO2、BG和Tc）的测定值，分析上述指标每年的达标情况，以评价PCAS患者的管理质量。结果@2005-2010年MAP、PaO：、PaCO：和BG的总达标率分别是72．14％、87．67％、38．33％和65．55％。72h期间温度控制在37．5℃以内，并且符合亚低温治疗标准者仅占21．43％。亚低温治疗复温后体温均有反跳。@2007～2010年PaO，的达标率较2005年有显著提高，差异有统计学意义（P〈0．05）；各年间其余指标的达标率差异无统计学意义（P〉0．05）。结论CPR后亚低温治疗患者的综合治疗质量仍需提高，尤其应强化对PaCO，和体温的管理力度。

Objective The aim of the present study is to investigate the quality of post resuscitation care （PRC） in the patients treated by mild hypothermia following cardio - pulmonary resuscitation （CPR） in order to evaluate the quality of PRC. Methods This investigation is a retrospective cohort study by means of collecting the following parameters： mean arterial pressure （MAP） , partial pressure of oxygen （ PaO2 ） , partial pressure of carbon dioxide （ PCO2 ） , blood glucose （BG） level and body core temperature （Te） in the patients treated by mild hypothermia following CPR during first 72 hours after admission in the Intensive Care Unit （ ICU ） of a teaching hospital during the period from January 1, 2005 to December 31, 2010. According to the criteria of parameters reaching satisfactory level, which are generally accepted in the literature, these parameters： MAP, PaO2, PaCO2 , BG and Tc were analyzed in order to find out how many percent these parameters would satisfy the criteria. Results （~From the year 2005 to 2010, the average rates of parameter reaching criteria of MAP, PaO2, PCO2 and BG, were 72. 14% , 87. 67% , 38. 33% and 65. 55% respectively. As temperature management is concerned, among the total 28 patients, only 21.43% patients meet the standard mild hypothermia treatment according to the guideline. In addition, after therapeutic hypothermia, all patients had experienced at least one onset of temperature rebound （ i.e. Tc 〉 37.5 ~C ） during the first 72 hours in the ICU. ~）While the rates of parameter reaching criteria of PaO2 from the year of 2007 to 2010 were compared with that of year 2005, there were significant differences （ P 〈 0. 05 ） ; but, there were not any significant differences in other parameters. Conclusion The quality of post resuscitation care should be improved, especially for the management of PaCO2 and body core temperature.