心肺复苏后目标温度管理对凝血功能的影响

The influence of targeted temperature management to the coagulation after cardiopulmonary resuscitation

目的研究心肺复苏(CPR)后患者后凝血功能障碍特点及目标温度管理(TTM)对其影响。方法选择近年于首都医科大学附属北京朝阳医院急诊室CPR后自主循环恢复(ROSC)患者(n=123),根据患者28 d的预后分为存活组(n=56)和死亡组(n=67);根据不同治疗方式分为TTM组(n=74)与非TTM组(n=49)。检测患者ROSC之后即刻和TTM结束后,或ROSC后72 h,或死亡前的凝血功能。结果各组患者一般临床资料无明显差异。所有患者ROSC后均存在明显凝血功能障碍,表现为凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)明显延长,纤维蛋白原(Fbg)和D-二聚体(D-dimer)明显增高,且各组间差异均无统计学意义(P>0.05)。无论行TTM与否,死亡组患者凝血功能进行性恶化,表现为PT、APTT进一步延长,凝血酶原活动度(PA)继续降低,D-dimer明显增加,与存活组相比差异具有统计学意义(P<0.05)。TTM与非TTM组凝血功能差异无统计学意义(P>0.05)。结论凝血功能障碍在心脏骤停复苏患者普遍存在,凝血功能进行性恶化对患者预后较差有一定提示意义,而TTM对凝血功能无显著影响。

Objective To investigate the influence of targeted temperature management(TTM)on the coagulation function in patients with return of spontaneous circulation(ROSC)after cardiopulmonary resuscitation(CPR).Methods A total of 123 patients with ROSC after CPR underwent TTM(n=74)or not(n=49).Whole blood samples were collected immediately after and 72 hours after ROSC,immediately after TTM,and/or before death to examine the levels of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fbg),and d-dimer coagulation indicis.Glasgow Coma Scale(GCS)score was collected immediately after admission into the ICU and APACH II score was collected 24 hours after admission.The patients were divided into the 2 groups according to the prognosis after 28 days:survival group(n=56)and death group(n=67).The influence of TTM was analyzed.Results There were not significant differences in age,sex,underlying diseases,and GCS score at admission between any different groups(all P>0.05).The APACH II score of the death group was significantly higher than that of the survival group(P<0.05).There were no significant differences in the coagulation indicis immediately after ROSC and 24 hours after TTM between any different groups(all P>0.05).Conclusion TTM does not significantly influence the coagulation in the patients with ROSC after CPR.