TCD联合APACHE Ⅱ评分在腹部心肺复苏脑功能预后中的价值

Clinical study of TCD combined with APACHE Ⅱ scores in the prognosis of neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation

目的探讨早期经颅多普勒超声(TCD)和APACHEⅡ评分对腹部心肺复苏术后患者脑功能复苏预后的评估价值。方法选取郑州人民医院医疗集团及三门峡中心医院所属急救站急诊经腹部心肺复苏救治成功后66例心搏骤停(CA)患者为研究对象进行回顾性病例对照研究,其中男性34例,女性32例;年龄19~80岁,平均(50.91±14.50)岁。患者根据复苏后3个月内的格拉斯哥-匹兹堡脑功能分级(CPC)分为预后良好组(CPC 1~CPC 2,29例)和预后不良组(CPC 3~CPC 5,37例)。比较两组患者腹部心肺复苏成功后24h经TCD测得的脑血流和APACHEⅡ评分结果,分析两指标的相关性并分别绘制对CA患者脑复苏预后预测的受试者工作特征(ROC)曲线,计算ROC曲线下面积以评估该指标对CA患者脑复苏预后预测的准确性。结果预后良好组CA患者腹部提压心肺复苏后24 h的脑血流明显高于预后不良组[(6.23±1.88)vs(4.88±1.15),P<0.05],APACHEⅡ评分明显低于预后不良组[(15.31±5.37)分vs(25.05±7.94)分,P<0.05],两者呈负相关性。脑血流对脑功能预后预测的曲线下面积为0.722,APACHEⅡ评分曲线下面积为0.844。结论心肺复苏早期脑血流越大、APACHEⅡ评分越低,患者脑功能预后越好。两者对腹部提压心肺复苏术后CA患者的脑功能预后评价具有指导意义。

Objective The aim of the study was to demonstrate that TCD and APACHE II scores can be used as predictors of the neurologic outcome after abdominal cardiopulmonary resuscitation. Methods A retrospective study was performed in a total of 66 cardiac arrest patients with abdominal cardiopulmonary resuscitation in Zhengzhou People’s Hospital and Sanmenxia center hospital were selected. There were 34 males and 32 females,whose age ranged from 19 years old to 80 years old with the mean age of 50. 91 ±14. 50 years. According to the Glasgow-Pittsburgh cerebral performance categories,the patients were divided into favorable prognosis group with the CPC1 ~ 2（ n = 29） and unfavorable prognosis group with the CPC3 ~ 5（ n = 37）. Two groups of patients’ CBF by TCD and APACHEⅡ scores were compared in 24 hours after successful abdominal cardiopulmonary resuscitation. The date was analyzed and receiver operating characteristic curves were made. Results CBF of favorable prognosis group was higher than that ofunfavorable prognosis group [（ 6. 23 ± 1. 88） vs（ 4. 88 ± 1. 15）,P 〈 0. 05 ],and APACHE Ⅱ scores was lower than that of unfavorable prognosis group[（ 15. 31 ± 5. 37） vs（ 25. 05 ± 7. 94）,P 〈 0. 05]. CBF had negative correlation with APACHE Ⅱ scores（ R =-0. 692,P 〈 0. 01）. ROC curves for unfavorable prognosis patients revealed an area under the curve of 0. 722 for CBF,and 0. 844 for APACHEⅡ scores.Conclusion The increasing CBF and decreasing APACHE Ⅱ scores were observed in patients with good outcome in brain function. So CBF and APACHEⅡ scores can be used as predictors of the brain function after abdominal cardiopulmonary resuscitation.