纳美芬联合亚低温治疗对心肺脑复苏患者预后的影响

Effect of nalmefene combined with mild hypothermia therapy on the prognosis of patients with cardiopulmonary resuscitation

目的探讨纳美芬联合亚低温治疗对心肺脑复苏患者预后的影响。方法选取2013年1月至2014年12月本院急诊及临床科室转入我科ICU的80例心肺复苏成功患者,按照不同病因分别采用随机数字表法分为观察组对照组各40例,观察组应用纳美芬联合亚低温治疗,对照组仅应用亚低温治疗,观察两组患者的预后情况。结果两组心肺复苏患者即刻血乳酸、格拉斯哥昏迷指数(GCS评分)、急性生理与慢性健康-Ⅱ评分(APACHEⅡ)比较差异无统计学意义(P>0.05);两组患者治疗72 h均能明显改善心肺复苏患者的血乳酸水平及APACHEⅡ评分,并能提高GCS评分,差异均有统计学意义(P<0.05),且治疗后观察组与对照组比较,血乳酸[(3.72±1.02)mmol/L vs(4.00±0.84)mmol/L],GCS评分[(7.12±2.14)分vs(5.03±1.62)分],APACHEⅡ评分[(16.00±3.73)分vs(18.90±2.54)分]的治疗效果更佳,差异均有统计学意义(P<0.05);7 d内观察组病死率为20.0%(8/40),低于对照组的40.0%(16/40),差异有统计学意义(P<0.05)。结论纳美芬联合亚低温治疗能改善心肺脑复苏患者的神经功能和组织脏器功能衰竭状态,降低神经系统的后遗症,提高患者短期预后。

Objective To investigate the effects of nalmefene combined with mild hypothermia therapy on the prognosis of patients with cardiopulmonary resuscitation(CPR). Methods Eighty patients with successful cardiopulmonary resuscitation who were transferred from clinical departments and Emergency Department into ICU from January2013 to Dec. 2014 were included in the study. The patients were divided into the observation group and the control group according to a random number table, with 40 cases in each group. The observation group applied nalmefene combined with mild hypothermia therapy for treatment, while the control group only used mild hypothermia therapy. The prognosis of the patients in the two groups was observed. Results After CPR, blood lactic acid, Glasgow Coma Scale(GCS) score, acute physiology and chronic health evaluation(APACHE Ⅱ) score showed no statistically significant difference between the two groups(P>0.05). 72 h treatment can significantly improve the blood lactate level and APACHEⅡ score, as well as the GCS score(P<0.05). Compared with control group, the observation group had significantly better blood lactic acid [(3.72±1.02) vs(4.00±0.84)], GCS score [(7.12±2.14) vs(5.03±1.62)], APACHE Ⅱ score [(16.00±3.73)vs(18.90 ± 2.54)], P<0.05. The mortality within 7 days of the observation group(20.0%, 8/40) was significantly lower than that of the control group(40.0%, 16/40), P<0.05. Conclusion Nalmefene combined with mild hypothermia therapy can improve cardiopulmonary cerebral resuscitation in patients with neurological function and organ failure, reduce neurological sequelae, and improve the short-term prognosis.