摘要
目的 明确早期乳酸清除率与心脏骤停（CA）后患者神经功能预后的相关性.方法 2009年1月至2014年9月镇江市第一人民医院重症医学科CA后恢复自主循环的患者共计74例,收集患者的一般临床资料,包括性别、年龄、CA原因、CA前心律、CA时间、抢救时间、ApacheⅡ评分、平均动脉压（MAP）,是否合并抽搐或中枢性高热,同时分别记录患者入科当时乳酸基础值及入科后6h乳酸值,计算患者6h乳酸清除率,并根据脑功能分级（CPC）将患者分为两组：神经功能预后较优组（CPC1-2级,A组）24例及神经功能预后较差组（CPC3-5级,B组）50例.比较两组患者一般临床资料、乳酸水平及乳酸清除率是否存在统计学差异,同时采用logistic回归分析各个临床指标以筛选出对神经功能预后的独立影响因素.结果 A、B两组相比较,性别、年龄、CA原因、CA前心律、Apache Ⅱ评分、MAP、合并抽搐或中枢性高热例数差异无统计学意义（P＞0.05）,CA时间、抢救时间组间比较差异有统计学意义（P＜0.05）;两组患者乳酸基础值差异无统计学意义（P＞0.05）,6h乳酸水平A组（5.3 mmol/L）低于B组（7.1 mmol/L）（t=-3.513）,6h乳酸清除率A组高于B组（48.8％比33.7％,t=2.835,P＜0.05）;logistic回归分析得出6h乳酸清除率及CA时间为影响其神经功能预后的独立因素.结论 早期乳酸清除率与CA后患者神经功能预后可能相关.
Objective To explore the correlations between early lactate clearance and the prognosis of neural function of patients with cardiac arrest （CA）.Methods The total number of patients with CA and restored spontaneous circulation was 74.Their general clinical data such as gender,age,cause of CA,heart rhythm pre-CA,CA duration,resuscitation time,Apache Ⅱ score,mean arterial pressure （MAP） and presence or absence of convulsion or central hyperthermia were recorded.The levels of lactate at admission and after 6 h＆#39;s therapy were also collected and used for calculating the 6 h lactate clearance rate for each patient.According to the cerebral performance category,they were divided into two groups of better neural function （CPC1-2,A,n =24） and worse neural function （CPC3-5,B,n =50）.General clinical data,lactate level and lactate clearance rate of two groups were compared to determine whether or not there was a significant difference.Logistic regression analysis was also used to select independent prognostic factors of neural function.Results No significant differences existed in gender,age,cause of CA,heart rhythm before CA,Apache Ⅱ score,MAP,number of cases with concurrent convulsion or central hyperthermia （P 〉 0.05）.And CA duration and save resuscitation time had significant inter-group differences （7.92 vs 11.16,17.47 vs 23.80,P 〈0.05）.The lactate level at admission had no significant inter-group difference （10.7 vs 11.2,P 〉 0.05） while the 6 h＆#39;s lactate level of group A was significantly less than that of group B （7.05 vs 5.26,P 〈 0.05）.And the 6 h lactate clearance rate in group A was also significant higher than that in group B （48.79% vs 33.67%,P〈0.05）.Logistic regression analysis revealed that 6 h lactate clearance rate and CA duratio were independent prognostic factors for neurological function in post-cardiac arrest patients.Conclusion Early lactate clearance may be associated with the prognosis of neural function for CA patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第19期1468-1470,共3页
National Medical Journal of China
关键词
心脏骤停
乳酸
代谢
预后
脑缺血缺氧
Heart arrest
Lactic acid
Metabolism
Prognosis
Brain ischemia anoxia
