自主循环恢复后血小板减少与院内心脏骤停患者短期预后的相关性分析

Correlation between thrombocytopenia and short-term prognosis of patients with in-hospital cardiac arrest after spontaneous circulation recovery

目的明确自主循环恢复后血小板减少与院内心脏骤停患者短期预后的相关性。方法回顾性分析2016年1月1日—12月31日四川大学华西医院急诊科发生院内心脏骤停患者的人口学资料、复苏后生命体征、复苏后实验室检查等资料和28 d死亡率。采用logistic回归分析心脏骤停患者自主循环恢复后血小板减少和28 d死亡率的相关性。结果在纳入的285例患者中,与血小板正常组(n=130)相比,血小板减少组(n=155)患者的红细胞计数、红细胞比容、白细胞计数、凝血酶原时间、活化部分凝血活酶时间、国际标准化比值差异有统计学意义(P<0.05);血小板减少组患者28 d死亡率高于血小板正常组患者(84.5%vs.71.5%,P=0.008)。多因素logistic回归分析显示,血小板减少[比值比=2.260,95%置信区间(1.153,4.429),P=0.018]及心肺复苏时间[比值比=1.117,95%置信区间(1.060,1.177),P<0.001]是院内心脏骤停患者28 d死亡的独立危险因素。结论自主循环恢复后血小板减少与院内心脏骤停患者短期不良预后相关。

Objective To investigate the relationship between thrombocytopenia after the restoration of spontaneous circulation and short-term prognosis of patients with in-hospital cardiac arrest.Methods The demographic data,post-resuscitation vital signs,post-resuscitation laboratory tests,and the 28-day mortality rate of patients who experienced in-hospital cardiac arrest at the Emergency Department of West China Hospital,Sichuan University between January 1st,2016 and December 31st,2016 were retrospectively analyzed.Logistic regression was used to analyze the correlation between thrombocytopenia after the return of spontaneous circulation and the 28-day mortality rate in these cardiac arrest patients.Results Among the 285 patients included,compared with the normal platelet group(n=130),the thrombocytopenia group(n=155)showed statistically significant differences in red blood cell count,hematocrit,white blood cell count,prothrombin time,activated partial thromboplastin time,and international normalized ratio(P<0.05).The 28-day mortality rate was higher in the thrombocytopenia group than that in the normal platelet group(84.5%vs.71.5%,P=0.008).Multiple logistic regression analysis indicated that thrombocytopenia[odds ratio=2.260,95%confidence interval(1.153,4.429),P=0.018]and cardiopulmonary resuscitation duration[odds ratio=1.117,95%confidence interval(1.060,1.177),P<0.001]were independent risk factors for 28-day mortality in patients with in-hospital cardiac arrest.Conclusion Thrombocytopenia after restoration of spontaneous circulation is associated with poor shortterm prognosis in patients with in-hospital cardiac arrest.