心搏骤停复苏后患者急性肝损伤发生的危险因素及对预后的影响

Risk factors for acute liver injury in patients after resuscitation from cardiac arrest and their infl uence on prognosis

目的探讨心搏骤停复苏后患者急性肝损伤发生的危险因素及对预后的影响。方法回顾性分析2015年1月至2018年1月间本科心肺复苏术后患者的临床资料,按照是否发生急性肝损伤(acute liver injury,ALI),将入选患者分为ALI组和非ALI组,比较两组患者入科时的基本情况及是否发生心搏骤停后休克及心功能不全。使用单因素生存曲线(Kaplan-Meier法)分析ALI对患者1年生存率的影响。观察ALI组患者的28 d病死率和神经功能恢复情况。使用多元逻辑回归分析ALI发生的危险因素。结果入选ALI组54人,非ALI组158人,ALI组患者恢复自主循环的时间较长[19(10~27)min,P=0.015],ALI组患者总体病情(SOFA评分、酸中毒和乳酸)较重。ALI组和非ALI组心搏骤停后休克和心功能衰竭的发生率分别为74%vs.55%和89%vs.70%。非ALI组患者的1年累计生存率明显高于ALI组,Log Rank(Mantel-Cox)χ^(2)=4.102,差异有统计学意义(P=0.043)。ALI持续时间越长,不良预后的发生率越高。心搏骤停后恢复自主循环的时间及心肺复苏后患者是否发生心力衰竭和ALI的发生相关,OR值分别为3.762(2.347~5.098)和4.272(2.943~5.932),P<0.05。结论心搏骤停后恢复自主循环的时间及心肺复苏后的心力衰竭是ALI的危险因素,ALI的发生增加患者病死率。

Objectives To investigate the risk factors for acute liver injury(ALI)in patients after resuscitation from cardiac arrest and their infl uence on prognosis.Methods The clinical data of patients after cardiopulmonary resuscitation in our department from January 2015 to January 2018 were analyzed.According to whether ALI occurred,the selected patients were divided into the ALI group and non-ALI group.The basic situation of the two groups of patients and the occurrence of shock and cardiac insuffi ciency after cardiac arrest were investigated.Kaplan-Meier method was used to analyze the effect of ALI on the 1-year survival of patients.The 28-day mortality and neurological recovery were observed in patients in the ALI group.Multivariate logistic regression was used to analyze the risk factors for ALI.Results:There were 54 patients in the ALI group and 158 patients in the non-ALI group.The patients in the ALI group needed a longer time to recover spontaneous circulation[19(10-27)min,P=0.015],and the overall condition(SOFA score,acidosis,and lactic acid)were more serious.The incidences of shock and heart failure after cardiac arrest in the ALI and non-ALI groups were 74%and 55%,and 89%and 70%,respectively.The 1-year cumulative survival rate of patients in the non-ALI group was signifi cantly higher than that of the ALI group(P=0.043).The longer the duration of ALI,the higher the incidence of poor prognosis.The time to resume spontaneous circulation(OR=3.762;95%CI:2.347-5.098)and heart failure(OR=4.272;95%CI:2.943-5.932)after cardiac arrest were associated with ALI in patients after cardiopulmonary resuscitation(both P<0.05).Conclusions The time to resume spontaneous circulation after cardiac arrest and heart failure after cardiopulmonary resuscitation are risk factors for ALI,and the occurrence of ALI increases patient’s mortality.