摘要
目的探讨心脏骤停后综合征(post-cardiac arrest syndrome,PCAS)患者早期平均动脉压(mean arterial pressure,MAP)与出院时神经功能预后的关系。方法回顾性分析河南省人民医院2016年1月至2018年1月收治入院的PCAS病例。纳入心肺复苏后自主循环恢复(restoration of spontaneous circulation,ROSC)超过12 h的患者共151例。建立多变量logistic回归分析模型,明确0~6 h MAP与受试者预后的关联性及关联性强度;通过卡方检验明确使用血管活性药物对出院时神经功能预后的影响。结果经多变量logistic回归分析,出院时神经功能预后良好组患者的时间加权平均动脉压(TWA-MAP)显著高于预后不良组,(83.25±13.69)mmHg vs(77.06±18.37)mmHg,P=0.042;ROSC后最初的6 h内的TWA-MAP值处于71~80 mmHg(1 mmHg=0.133 kPa)组患者的良好神经功能预后率明显优于TWA-MAP小于70 mmHg的患者(11%vs 37%,P=0.009);且TWA-MAP大于70 mmHg与大于65 mmHg均是影响患者预后的独立影响因素,但TWA-MAP大于70 mmHg对神经功能预后良好的影响显著(OR=4.11,95%CI:1.34~12.66,P=0.014);在TWA-MAP达到了70 mmHg以上的患者中,未使用血管活性药物的患者良好神经功能预后率显著高于使用血管活性药物组的患者(48%vs 24%,P=0.010)。结论在PCAS的6 h内保持TWA-MAP大于70 mmHg有利于改善患者出院时神经功能预后。
Objective To discuss the relationship between neurofunctional prognosis and early mean arterial pressure(MAP)of patients with post-cardiac arrest syndrome(PCAS).Methods This retrospective study enrolled 151 PCAS patients in Henan Provincial People’s Hospital between January 2016 and January 2018.A multivariate logistic regression analysis was established to determine the correlation between the MAP at the first 6 h and the prognosis of the patients at discharge.The effect of angioactive drugs on the neurofunctional prognosis of patients at discharge was determined by chi-square test.Results The multivariate logistic regression analysis showed that the TWA-MAP of patients with good neurofunctional prognosis at discharge was significantly higher than that of patients with poor prognosis(83.25±13.69)mmHg vs(77.06±18.37)mmHg,P=0.042.In the first 6 h after ROSC,the neurofunctional prognosis of patients with good prognosis in the TWA-MAP value of 71 to 80 mmHg was significantly better than that of patients with TWA-MAP lower than 70 mmHg(11%vs 37%,P=0.009).The variable logistic regression analysis results showed that the level of TWA-MAP higher than 70 mmHg or 65 mmHg was the independent factor affecting the outcome,while the level of TWA-MAP higher than 70 mmHg had a better correlation with the neurofunctional prognosis(OR=4.11,95%CI:1.34-12.66,P=0.014).In patients with TWA-MAP higher than 70 mmHg,the neurofunctional prognosis of patients with good prognosis but without angioactive drugs was significantly better than that of those with angioactive drugs(48%vs 24%,P=0.010).Conclusion Holding TWA-MAP higher than 70 mmHg in the first 6 h after PCAS is helpful to improve the neurofunctional prognosis of patients at discharge.
作者
许丽君
崔英杰
秦历杰
Xu Lijun;Cui Yingjie;Qin Lijie(Emergency Department,Henan Provincial People’s Hospital,Zhengzhou 450003,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第5期711-715,共5页
Chinese Journal of Emergency Medicine
基金
河南省医学科技攻关计划(201602270)。
关键词
回顾性研究
脑损伤
心肺复苏
心脏骤停后综合征
神经功能预后
影响因素
平均动脉压
时间加权平均动脉压
Retrospective study
Brain injury
Cardiopulmonary resuscitation
Post-cardiac arrest syndrome
Neurofunctional prognosis
Influencing factor
Mean arterial pressure
Time-weighted average mean arterial pressure
