心肺复苏后患者局部脑氧饱和度与神经元特异性烯醇化酶水平的变化

Changes of regional saturation of cerebral oxygenation and neuron specific enolase in patients after cardiopulmonary resuscitation

目的观察心肺复苏(CPR)后患者局部脑氧饱和度(rScO2)与血中神经元特异性烯醇化酶(NSE)的变化,并探讨其对患者神经功能预后评估的价值。方法选择2012年1月至2020年12月苏州大学附属第二医院综合重症监护病房(ICU)收治的心搏骤停后自主循环恢复(ROSC)的97例患者作为研究对象,根据神经功能预后将患者分为预后良好组〔格拉斯哥-匹兹堡脑功能分级(CPC)为1~2级,20例〕和预后不良组(CPC为3~5级,77例)。收集患者的性别、年龄、可除颤心律患者数、ROSC时间、院外心搏骤停患者数、入院时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、格拉斯哥昏迷评分(GCS)、全面无反应性量表(FOUR)评分、体温、平均动脉压(MAP)、血乳酸(Lac)和出院时GCS,以及ICU住院时间、rScO2、血中NSE等临床资料。比较不同神经功能预后两组患者rScO2、NSE的差异;绘制受试者工作特征曲线(ROC曲线),评估rScO2、NSE单独及联合检测对心搏骤停ROSC患者神经功能预后的预测价值。结果预后良好组ROSC 1、3、6、12、24、48 h rScO2均明显高于预后不良组(均P<0.05),且ROCS 24 h预后良好组左右两侧rScO2也均明显高于预后不良组〔左侧:0.65(0.59,0.76)比0.55(0.44,0.67),右侧:0.62(0.61,0.73)比0.50(0.30,0.69),均P<0.05〕,NSE明显低于预后不良组〔ng/L:21.42(15.38,29.69)比45.82(24.05,291.26),P<0.05〕。ROC曲线分析提示,rScO2、NSE单独及两者联合检测对心搏骤停ROSC患者神经功能预后均有一定的预测价值,且两指标联合检测的ROC曲线下面积(AUC)最大,高于rScO2、NSE单个指标预测的AUC(0.904比0.884、0.792);当二者联合的截断值为0.83时,其敏感度和特异度分别为75.7%和100%。结论监测rScO2和NSE能预测CPR ROSC患者神经功能预后,特别是两指标联合评估大大提高了诊断的准确性。

Objective To observe the changes of regional saturation of cerebral oxygenation(rScO2)and blood neuron specific enolase(NSE)in patients after cardiopulmonary resuscitation(CPR),and to explore its value in evaluating the prognosis of patients'neurological function.Methods From January 2012 to December 2020,97 patients with return of spontaneous circulation(ROSC)after cardiac arrest(CA)treated in the intensive care unit(ICU)of the Second Affiliated Hospital of Soochow University were selected.According to the prognosis,the patients were divided into two groups:good neurological function group[Glasgow-Pittsburgh Cerebral Performance Categories(CPC)1-2,20 cases]and neurological dysfunction group(CPC classification 3-5,77 cases).The clinical data of gender,age,the number of patients with defibrillable rhythm,time of ROSC,the number of CA patients outside the hospital,acute physiology and chronic health evaluationⅡ(APACHEⅡ),Glasgow coma scale(GCS),global non-response scale(FOUR),body temperature,mean arterial pressure(MAP),blood lactic acid(Lac)and GCS at discharge,as well as the length of ICU stay,rScO2 and blood NSE were collected.The differences of rScO2 and NSE between the two groups were compared;and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the value of rScO2 and NSE alone or in combination in predicting the prognosis of patients with ROSC after CA.Results The rScO2 of good neurological function group was significantly higher than that of neurological dysfunction group at 1,3,6,12,24 and 48 hours(all P<0.05).At 24 hours after admission,the rScO2 on the left and right sides of good neurological function group was significantly higher than that in neurological dysfunction group[left:0.65(0.59,0.76)vs.0.55(0.44,0.67),right:0.62(0.61,0.73)vs.0.50(0.30,0.69),both P<0.05],and NSE was significantly lower than that in the neurological dysfunction group[ng/L:21.42(15.38,29.69)vs.45.82(24.05,291.26),P<0.05].ROC curve analysis showed that both rScO2 and NSE alone and combined detection had a certain value in predicting the prognosis of neurological function in patients with ROSC after CA,and the area under the ROC curve(AUC)detected by the combination was the largest,which was higher than the AUC predicted by rScO2 or NSE(0.904 vs.0.884,0.792).When the cut-off value of combination was 0.83,the sensitivity and specificity were 75.7%and 100%respectively.Conclusion Monitoring rScO2 and NSE can predict the prognosis of neurological function after CPR,especially the combined evaluation of the two indexes,which can greatly improve the accuracy of diagnosis.