院内心搏骤停患者机械通气时机的选择及与预后的关系

Study on the relationship between mechanical ventilation initiation time and prognosis of in-hospital cardiac arrest patients

目的探讨在心肺复苏（CPR）过程中进行机械通气（MV）的时机与院内心搏骤停（IHCA）患者预后的关系。方法回顾性分析2011年1月至2016年4月在河西学院附属张掖人民医院治疗的IHCA患者的临床资料，纳入CPR后自主循环恢复（ROSC）且年龄〉18岁的MV患者。根据患者开始CPR至进行MV的时间分为MV早期组（≤10min）和MV晚期组（〉10min）。观察两组患者CPR开始后24h角膜反射、瞳孔反射、疼痛躲避反应和运动反应，以及CPR成功率及出院时神经功能等指标。结果最终纳入210例患者，男性130例，女性80例；平均年龄（60．24±13．17）岁。MV早期组124例，MV晚期组86例，两组患者性别、年龄、心律类型及心搏骤停（CA）原因等基线资料均衡可比。MV早期组24h有角膜反射、瞳孔反射、疼痛躲避反应、运动反应的患者比例及CPR成功率均明显高于MV晚期组（59．68％比31．40％，59．68％比31．40％，54．84％比24．42％，54．84％比24．42％，70．16％比51．16％，均P〈0．01）；MV早期组CPR后血D-二聚体水平明显低于MV晚期组（μg/L：478．39±57．21比510．05±62．83，P〈0．01），而血pH值比较差异无统计学意义（7．24±0．72比7．13±0．67，P〉0．05）；MV早期组住院时间明显短于MV晚期组（d：24．15±3．04比30．28±4．17，P〈0．01），而存活出院率则明显高于MV晚期组（41．94％比26．74％，P〈0．05）；MV早期组出院时神经功能1-2级的患者比例明显高于MV晚期组（44．35％比15．12％，P〈0．01）。结论在IHCA患者CPR早期（≤10min）建立MV有利于改善机体缺氧状况和神经功能预后，提高CPR成功率。

Objective To investigate the correlation between mechanical ventilation （MV） initiation time during cardiopulmonary resuscitation （CPR） and the prognosis of patients with in-hospital cardiac arrest （IHCA） in emergency Methods Retrospective analysis of clinical records of patients with IHCA in emergency from January 2011 to April 2016 treated in Zhangye People＇s Hospital of Hexi University was performed. Patients with restoration of spontaneous circulation （ROSC） and were on MV with aged over 18 years were divided into early treated group （≤ 10 minutes） and later treated group （〉 10 minutes） according to the initiation time of MV. Corneal reflex, pupillary reflex, pain- avoidance responses and motor response 24 hours after CPR, neurological function and cure rate of the two groups were analyzed. Results 210 patients were selected into our study including 130 males and 80 females （mean age： 60.24± 13.17 years）. There were no significant differences in gender, age, type of heart rate and etiological factor of cardiac arrest （CA） between the MV early stage group （124 cases） and the MV late stage group （86 cases）. The restoration of corneal reflex, pupillary reflex, pain-avoidance responses, motor response and achievement ratio of CPR in early group were higher than those of later group （respectively, 59.68% vs. 31.40%, 59.68% vs. 31.40%, 54.84% vs. 24.42%, 54.84% vs. 24.42%, 70.16% vs. 51.16%, all P 〈 0.01）; The D-dimer levels in the early group patients were significantly lower than those in the later group （μg/L： 478.39 ± 57.21 vs. 510.05 ± 62.83, P 〈 0.01）. However, no statistical difference was observed between the two groups with respect to pH （7.24 ± 0.72 vs.7.13 ± 0.67, P 〉 0.05）; The average hospitalized day of the early group was significantly shorter than that of the later group （days： 24.15 ± 3.04 vs. 30.28 ± 4.17, P 〈 0.01）; Besides, the early group showed a higher survival rate at discharge and had more cases with neurologie level of grade 1-2 than those of the later group （Respectively, 41.94% vs. 26.74%, P 〈 0.05; 44.35% vs. 15.12%, P 〈 0.01）. Conclusion Initiation MV on IHCA patients in the early stage of CPR （≤ 10 minutes） could help improve the hypoxic condition and prognosis of neurological function, and increase the achievement ratio of CPR.