心肺复苏中早期机械通气干预对患者氧代谢、颅内压及脑功能的影响

Effect of Early Mechanical Ventilation Intervention on Oxygen Metabolism,Intracranial Pressure and Brain Function in Patients under Cardiopulmonary Resuscitation

目的分析早期机械通气在心肺复苏中的应用效果,观察心肺复苏后患者氧代谢、颅内压及脑功能指标变化情况。方法选取我院2012年1月-2017年1月235例行心肺复苏的心脏骤停患者为研究对象,根据插管时机将患者分为早期组与延迟组。102例在5 min内插管成功者纳入早期组,133例超过5 min插管成功纳入延迟组。比较两组患者的复苏成功率、血气指标、脑氧代谢、血清细胞因子、血流动力学、颅内压、复苏情况、昏迷程度以及脑复苏转归。结果早期组心肺复苏成功率(27.5%)显著高于延迟组(6.8%),P<0.05。早期组自主循环恢复后24 h颈内静脉血氧含量(CajvO_2)、脑氧摄取率(ERO_2)、血清神经元特异性烯醇化酶(NSE)、S100蛋白(S100β)、颅内压分别为(70.53±6.42)ml/L、(25.96±2.05)%、(53.89±11.76)μg/L、(6.34±0.79)μg/L、(28.97±4.52)mm Hg,均显著低于延迟组的(65.26±5.18)ml/L、(24.58±1.83)%、(62.46±14.92)μg/L、(6.92±0.71)μg/L、(32.36±6.15)mm Hg(P<0.05)。结论心脏骤停发生后应尽快气管插管行机械通气,以提高患者心肺复苏成功率,保护神经功能。

Objective To analyze the effect of early mechanical ventilation intervention on oxygen metabolism,intracranial pressure and brain function in patients undergoing cardiopulmonary resuscitation.Methods A total of 235 cases with cardiac arrest who had undergone cardiopulmonary resuscitation in our hospital between January 2012 and January 2017 were enrolled in this study.According to the timing of intubation,patients were divided into the early group(n=102,the tube was inserted within 5 min)and the delayed group(n=133,the tube was inserted after 5 min).The success rate of resuscitation,blood gas indexes,cerebral oxygen metabolism,serum cytokines,hemodynamics,intracranial pressure,condition of resuscitation,degree of coma and outcome of cerebral resuscitation were compared between the two groups.Results The success rate of cardiopulmonary resuscitation in the early group was significantly higher than that in the delayed group(27.5%vs 6.8%)(P<0.05).At 24 h after the recovery of autonomic circulation,the blood oxygen content in the internal jugular vein(CajvO2),brain oxygen uptake(ERO2),serum neuron specific enolase(NSE),S100 protein(S100 beta)and intracranial pressure in the early group were〔(70.53±6.42)ml/L,(25.96±2.05)%,(53.89±11.76)μg/L,(6.34±0.79)μg/L and(28.97依4.52)mmHg页respectively,significantly lower than those in the delayed group也(65.26依5.18)ml/L,(24.58依1.83)%,(62.46依14.92)滋g/L,(6.92依0.71)滋g/L and(32.36依6.15)mmHg页(P<0.05).Conclusion Tracheal intubation and mechanical ventilation should be performed as soon as possible after cardiac arrest so as to improve the success rate of cardiopulmonary resuscitation and protect the nerve function.