心脏骤停CPR后脑复苏期间ScVO_2、DO_2、血乳酸和GCSP评分联合检测对预后的评估价值

The application value of the combination detection of ScVO_2, DO_2, blood lactate and GCSP scores in prognosis evaluation of patients with cardiac arrest after CPR

目的了解心脏骤停患者进行CPR脑复苏之后,体内中心静脉血氧饱和度、脑供氧、脑供氧和格拉斯哥匹斯堡昏迷评分对患者预后结局评估的临床使用价值。方法 2013年1月至2016年7月对急诊科收治的符合研究要求的113例因心脏骤停而进行心肺复苏的患者进行研究,分析患者不同监测时点各项指标(ScVO_2、DO_2、血乳酸、GCSP评分)含量的变化,分析某监测时点3组患者(生存>24 h的76例、12 h和24 h的25例、<12 h的12例)各项指标含量的差异,分析各观测指标对患者预后生存时间的综合影响。结果 113例患者预后结局分为:>24 h的76例(67.26%)、12～24 h的25例(22.12%)、<12 h的12例(10.62%);不同监测时点比较,3组患者各项监测指标(ScVO_2、DO_2、血乳酸、GCSP评分)的差异均有统计学意义(均有P<0.05);3组之间各项监测指标比较,T0时3组之间的差异不显著(均有P>0.05);ScVO_2指标T1时3组之间(>24 h和<12 h)、T2时3组之间的差异均有统计学意义(均有P<0.05);DO_2、血乳酸、GCSP评分均有T1时3组之间、T2时3组之间的差异均有统计学意义(P<0.05);四项指标联合检测对患者预后结局评估的灵敏度(1.000)、特异度(0.989)和约登指数(0.989)均最高,单项指标用于患者预后结局评估时,其灵敏度大小依次为:ScVO_2(0.632)、DO_2(0.590)、血乳酸(0.583)、GCSP评分(0.450);各指标对患者预后结局影响大小依次为:ScVO_2(OR=25.894)、DO_2(OR=16.055)、血乳酸(OR=5.720)、GCSP(OR=3.789)。结论不同预后结局的心脏骤停患者(CPR)其体内ScVO_2、DO_2、血乳酸含量和GCSP评分随着时间迁移具有不同程度的改变,尤其是生存时间>24 h的患者相比生存时间12～24 h(或<12 h)的患者,各项指标和GCSP评分变化尤为明显,各项指标联合检测用于患者预后判定有一定实用价值。

Objective To evaluate the application value of the combination detection of ScVO2, DO2, blood lactate and GCSP scores in prognosis evaluation of patients with cardiac arrest after CPR.Methods A total of 113 patients who underwent cardiopulmonary resuscitation(CPR) due to cardiac arrest in our hospital from January 2013 to July 2013, were enrolled in the study. The changes of ScVO2, DO2, blood lactic acid and GCSP score at different monitoring time points were analyzed. Moreover, the differences in the indexes at a certain monitoring time point in the three groups( 76 cases with survival time>24 h, 25 cases with survival time during 12 h^24 h and 12 cases with survival time<12 h) as well as the comprehensive effects of each index on the prognosis survival time od patients were analyzed.Results The prognosis of 113 patients was as follows: the survival time >24 h in 76 cases(67.26%), that during 12~24 h in 25 cases(22.12%) and that <12 h in 12 cases(10.62%). There were significant differences in ScVO2, DO2, blood lactic acid and GCSP score at different monitoring time points among the three groups(P<0.05). There were no significant differences in the indexes at T0 among the three groups(P>0.05), whereas there were significant differences in ScVO2 at T1 and T2 among the three groups(P<0.05). There were significant differences in DO2, blood lactic acid and GCSP score at T1 and T2 among the three groups(P<0.05). The sensitivity(1.000), specificity(0.989) and Youden index(0.989) of prognosis were the highest by means of combination detection. In terms of single index, the sensitivities of ScVO2(0.632) were the highest, followed by DO2(0.590), blood lactic acid(0.583) and GCSP(0.450), respectively. ScVO2(OR=25.894) had the greatest impact on prognosis, followed by DO2(OR=16.055) blood lactic acid(OR=5.720) and GCSP(OR=3.789).Conclusion In cardiac arrest patients with different prognosis after CPR, different degrees of changes of ScVO2, DO2, blood lactate content and GCSP score are observed with the time going on. Especially in patients with survival time >24 h, the changes of various indexes and GCSP scores are particularly obvious,as compared with those with survival time during 12 ~ 24( or < 12 h). Therefore,the combination detection is of practical value in evaluating prognosis of patients.