对比腹部提压CPR与胸外按压CPR对窒息性心脏停搏患者术后脑功能预后的影响

Comparison of neurologic outcome between active abdominal compression-decompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation in asphyxia cardiac arrest

目的比较腹部提压心肺复苏术（AACD-CPR）与标准胸外按压心肺复苏术（STD-CPR）对窒息所致心脏停搏（CA）患者术后脑功能的预后。 方法采用前瞻性多中心随机对照临床试验（RCT），纳入2014年6月至2017年12月郑州人民医院、三门峡市中心医院收治的因溺水、异物吸入等窒息引起的CA成人患者。在患者家属知情同意的情况下，按照随机数字表法将患者分为AACD-CPR组和STD-CPR组。于患者自主循环恢复（ROSC）后1、6、12、24、48 h抽取肘正中静脉或贵要静脉血，采用酶联免疫法检测S100B蛋白及神经元特异性烯醇化酶（NSE）水平；3个月后行脑功能分级（CPC分级）。 结果共入选183例患者，其中CPR后ROSC 78例；剔除CA〉8 min、抢救时间〉1 h者，最终纳入69例ROSC患者（STD-CPR组36例，AACD-CPR组33例）。两组ROSC后血S100B蛋白和NSE水平逐渐升高，均于6 h达高峰，随后逐渐下降。AACD-CPR组ROSC后各时间点S100B蛋白和NSE含量均明显低于STD-CPR组〔S100B蛋白（μg/L）：1 h为1.62±0.52比1.88±0.46，6 h为1.71±0.41比2.02±0.58，12 h为1.24±0.37比1.52±0.59，24 h为1.05±0.23比1.28±0.37，48 h为0.82±0.29比1.05±0.36；NSE（μg/L）：1 h为24.76±3.02比26.78±4.29，6 h为58.78±5.58比61.68±5.44，12 h为53.87±4.84比56.78±5.68，24 h为40.96±3.52比43.13±4.50，48 h为33.23±2.89比35.54±3.44，均P〈0.05〕。AACD-CPR组患者3个月后CPC分级明显低于STD-CPR组（平均秩次：28.86比42.46，Z=-3.375，P〈0.001）。 结论对于因窒息所致的CA患者，AACD-CPR比STD-CPR更有利于脑功能的恢复。

ObjectiveTo compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation （AACD-CPR） and chest compression cardiopulmonary resuscitation （STD-CPR） in asphyxia cardiac arrest （CA）.MethodsA prospective multicenter randomized controlled trial （RCT） was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People＇s Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients＇ families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation （ROSC）, and the levels of S100B protein and neuron-specific enolase （NSE） were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification （CPC） after 3 months.ResultsA total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA 〉 8 minutes and rescue time 〉 1 hour were excluded, 69 ROSC patients （36 in STD-CPR group and 33 in AACD-CPR group） were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein （μg/L）： 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE （μg/L）： 24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P 〈 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group （average rank： 28.86 vs. 42.46, Z = -3.375, P 〈 0.001）.ConclusionAfter suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.