低温生理盐水协同诱导亚低温对心肺复苏后昏迷患者的影响

Effects of mild therapeutic hypothermia induced by hypothermic normal saline on patients with coma following the cardio-pulmonary resuscitation

目的:探讨低温生理盐水协同诱导亚低温对心肺复苏后昏迷患者的影响。方法:选择2019年4月至2021年4月九江市第一人民医院收治的60例心肺复苏后持续昏迷患者作为研究对象,按随机数字表法将患者分为观察组和对照组,各30例。观察组于心肺复苏自主循环恢复0.5 h内,给予患者静脉注射30~40 ml/kg低温生理盐水(4℃)进行亚低温早期诱导,对照组则在相同时间内给予同等剂量的常温生理盐水进行静脉注射。所有患者在自主循环功能恢复0.5 h后进行常规亚低温治疗。观察两组患者生命体征、脑电图异常情况、昏迷程度及预后情况。结果:注入低温生理盐水前后两组患者生命体征差异均无统计学意义(P>0.05)。观察组脑电图轻度异常发生率高于对照组,中度异常和重度异常发生率均低于对照组(P均<0.05)。观察组脑电图低电压/电静息发生率低于对照组,慢波增多发生率高于对照组(P<0.05)。两组注入生理盐水后30、60 min格拉斯哥昏迷评分(GCS)均明显升高(P<0.05),注入后60 min观察组GCS评分明显高于对照组(P<0.05)。对照组死亡4例,观察组无一例死亡,观察组预后不良发生率低于对照组(P<0.05)。结论:低温生理盐水协同诱导亚低温能改善心肺复苏后昏迷患者预后,降低死亡率,脑电图对预后评估具有一定价值。

Objective:To explore the effects of mild therapeutic hypothermia induced by hypothermic normal saline on patients with coma following the cardio-pulmonary resuscitation.Methods:Sixty patients with coma following the cardio-pulmonary resuscitation in Jiujiang First People's Hospital from April 2019 to April 2021 were randomly divided into observation group and control group,with 30 cases in each group.Patients in the observation group were intravenously injected with 30-40 ml/kg low-temperature normal saline(4℃)for early induction of mild hypothermia within 0.5 h after spontaneous circulation recovery,while patients in the control group were intravenously injected with the same dose of normal temperature normal saline.All patients received routine mild hypothermia treatment after the autonomic circulation function recovered for 0.5 h.The vital signs,abnormal EEG,coma degree and prognosis in the two groups were observed.Results:There was no significant difference in vital signs between the two groups before and after low-temperature normal saline injection(P>0.05).The incidence rate of mild abnormal EEG in the observation group was higher than that in the control group,while the incidence rate of moderate and severe abnormal EEG was lower than that in the control group(P<0.05).The incidence rate of low voltage/electric rest in EEG in the observation group was lower than that in the control group,and the incidence rate of slow wave increase was higher(P<0.05).The Glasgow coma score(GCS)of the two groups was significantly increased at 30 and 60 min after injection of normal saline(P<0.05),and the GCS in the observation group was significantly higher than that in the control group at 60 min after injection(P<0.05).There were 4 deaths in the control group and no death in the observation group,and the incidence of poor prognosis in the observation group was lower than that in the control group(P<0.05).Conclusion:Mild therapeutic hypothermia induced by hypothermic normal saline can improve the prognosis and reduce the mortality of patients with coma following the cardio-pulmonary resuscitation.EEG has certain value in evaluating prognosis.