CRRT联合心肺复苏机在心搏骤停患者抢救中的应用及对患者心肺复苏及生存预后的影响

Application of CRRT combined with CPR machine in rescue of patients with cardiac arrest and the influence of that on CPR and survival prognosis of patient

目的:探讨连续性肾脏替代疗法(CRRT)联合心肺复苏机在心搏骤停患者抢救中的应用及对患者心肺复苏(CPR及生存预后的影响。方法:选取医院收治的120例心搏骤停患者,按照抢救方式的不同将采用CRRT救治的58例患者纳入对照组,采用CRRT联合心肺复苏机救治的62例患者纳入观察组。比较两组患者气道开放、呼吸恢复、恢复自主循环时间、CPR成功率及脑复苏成功率,以及入院即刻、心肺复苏1 h和6 h的左心室射血分数(LVEF)、左心室舒张早期充盈峰最大充盈速度与舒张晚期充盈峰最大峰值速度比值(E/A)、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))及PaO_(2)与氧体积分数(FiO_(2))比值(PaO_(2)/FiO_(2))。采用格拉斯哥-匹兹堡脑功能分级(CPC)评估患者神经功能恢复情况,CPR成功后均随访6个月,比较两组患者生存情况。结果:观察组患者气道开放、呼吸恢复以及恢复自主循环时间均明显低于对照组,差异有统计学意义(t=3.117,t=8.697,t=2.540;P<0.05);CPR成功率和脑复苏成功率均明显高于对照组,差异有统计学意义(x^(2)=1.010,x^(2)=2.540;P<0.05);CPR成功后1 h的LVEF、E/A均明显高于对照组,差异有统计学意义(t=4.205,t=3.671;P<0.05)。两组入院即刻、心肺复苏1h和6 h的PaO_(2)、PaCO_(2)及PaO_(2)/FiO_(2)比较,差异均无统计学意义;两组入院即刻、心肺复苏1h和6 h的LVEF和E/A比较,差异均有统计学意义(F=5.346,F=3.198;P<0.05)。LVEF、E/A、PaO_(2)及PaO_(2)/FiO_(2)随时间的推移逐渐增加,PaCO_(2)随时间的推移逐渐减少,观察组CPC中1~2级例数占比明显高于对照组,3~5级例数占比明显低于对照组,差异有统计学意义(x^(2)=7.490,x^(2)=7.490;P<0.05)。两组患者CPR成功后随访6个月,观察组中位生存时间为152.13 d,对照组中位生存时间为112.36 d,两组比较差异有统计学意义(x^(2)=9.121,P<0.05)。结论:采用CRRT联合心肺复苏机救治可有效缩短气道开放、呼吸恢复及恢复自主循环时间,提高CPR成功率和脑复苏成功率,改善LVEF、E/A心功能指标,降低CPC分级,延长患者的生存时间。

Objective:To explore the application of continuous renal replacement therapy(CRRT)combined with cardiopulmonary resuscitation(CPR)machine in the rescue of patients with cardiac arrest and the influence of that on CPR and survival prognosis of patient.Methods:A total of 120 patients with cardiac arrest admitted to our hospital were selected as the study subjects.According to the different rescue methods,58 patients received CRRT rescue were divided into control group,and 62 patients received CRRT combined with CPR machine were divided into observation group.The airway opening,respiratory recovery,time of recovering spontaneous circulation,CPR success rate and success rate of cerebral resuscitation,and left ventricular ejection fraction(LVEF),as well as the ratio(E/A)of the maximum filling velocity of the left ventricular early diastolic filling peak to the maximum peak velocity of the late diastolic filling peak,arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),and the ratio of PaO_(2) to oxygen volume fraction(FiO_(2))at the immediately upon admission,the first and sixth hour after CPR between two groups were compared.Glasgow Pittsburgh cerebral performance category(CPC)was used to assess the recovery conditions of neurological functions of patients.After CPR succeeded,all patients were followed up for half a year,so as to compare the survival conditions of the two groups.Results:The times of airway opening,respiratory recovery and recovery of spontaneous circulation in the observation group were significantly lower than those of the control group(t=3.117,t=8.697,t=2.540,P<0.05),respectively.The LVEF and E/A at the 1st h after CPR succeeded in the observation group were significantly higher than those of the control group(t=4.205,t=3.671,P<0.05),respectively.There were no significant differences between two groups in the PaO_(2),PaCO_(2) and PaO_(2)/FiO_(2) at the immediately upon admission,the first and sixth hour after CPR.There were significant differences in LVEF and E/A at the immediately upon admission,the first and sixth hour after CPR between two groups(F=5.346,F=3.198,P<0.05),respectively.With the changing of time,the LVEF,E/A,PaO_(2) and PaO_(2)/FiO_(2) gradually increased,while the PaCO_(2) gradually decreased.The proportion of grades I and II in CPC of the observation group was significantly higher than that of the control group,while the proportion of grades III-V in CPC of the observation group was significantly lower than that of the control group(x^(2)=7.490,x^(2)=7.490,P<0.05),respectively.In the half a year of follow up after CPR succeeded,the median survival times of observation group and control group were respectively 152.13d and 112.36d,and the differences of them between two groups were significant(x^(2)=9.121,P<0.05),respectively.Conclusion:The combined treatment of CRRT and CPR machine can effectively shorten the times of airway opening,respiratory recovery and recovery of spontaneous circulation,and increase the success rates of CPR and cerebral resuscitation,and improve the LVEF and E/A of cardiac function indicators,and reduce CPC grading,and prolong the survival time of patients.