CAJ | 학술논문

目的探讨经颅多普勒(transcranial Doppler,TCD)测得的搏动指数和血清神经元特异烯醇化酶(neuron-specific enolase,NES)对成功心肺复苏患者的预测价值.方法心肺复苏恢复自主循环仍处昏迷状态的患者分为生存组和死亡组.心肺复苏恢复自主循环后48 h行TCD监测和血清NSE检测.采用ROC曲线评价TCD测得的搏动指数和血清NSE含量对成功心肺复苏患者的预测价值.结果共收集病例70例,生存组32例,其中男性19例,女性13例,平均年龄(54.63±13.28)岁;死亡组38例,其中男性22例,女性16例,平均年龄(58.00±13.15)岁.生存组性别构成和年龄与死亡组无显著差异.死亡组搏动指数为1.217±0 352,显著高于生存组的0.841±0.163;死亡组血清NSE含量为(130.968±59.634)ng/ml,显著高于生存组的(49.465±26 864)ng/ml(P＜0.01).以搏动指数预测患者死亡时,ROC曲线下面积为0.794(P=0.000,95%可信区间0.679～0.908);截断值为1.110时,敏感性为68.4%,特异性为100%,阳性预测值为100%,阴性预测值为72.7%.以血清NSE水平预测患者死亡时,ROC曲线下面积为0.756(P=0.000,95%可信区间0.672～0.885);截断值为56.502 ng/ml时,敏感性为80.8%,特异性为65.4%,阳性预测值为82.5%,阴性预测值为76.6%.结论 TCD测的搏动指数和血清NSE含量可作为心肺复苏后自主循环恢复患者的预测指标.
목적 탐토경로다보륵(transcranial Doppler,TCD)측득적박동지수화혈청신경원특이희순화매(neuron-specific enolase,NES)대성공심폐복소환자적예측개치.방법 심폐복소회복자주순배잉처혼미상태적환자분위생존조화사망조.심폐복소회복자주순배후48 h행TCD감측화혈청NSE검측.채용ROC곡선평개TCD측득적박동지수화혈청NSE함량대성공심폐복소환자적예측개치.결과 공수집병례70례,생존조32례,기중남성19례,녀성13례,평균년령(54.63±13.28)세;사망조38례,기중남성22례,녀성16례,평균년령(58.00±13.15)세.생존조성별구성화년령여사망조무현저차이.사망조박동지수위1.217±0 352,현저고우생존조적0.841±0.163;사망조혈청NSE함량위(130.968±59.634)ng/ml,현저고우생존조적(49.465±26 864)ng/ml(P＜0.01).이박동지수예측환자사망시,ROC곡선하면적위0.794(P=0.000,95%가신구간0.679～0.908);절단치위1.110시,민감성위68.4%,특이성위100%,양성예측치위100%,음성예측치위72.7%.이혈청NSE수평예측환자사망시,ROC곡선하면적위0.756(P=0.000,95%가신구간0.672～0.885);절단치위56.502 ng/ml시,민감성위80.8%,특이성위65.4%,양성예측치위82.5%,음성예측치위76.6%.결론 TCD측적박동지수화혈청NSE함량가작위심폐복소후자주순배회복환자적예측지표.
Objective To investigate the predictive values of the pulsatility index detected by transcranial Doppler (TCD) and serum neuron-specific enolase (NES) in patients achieved return of spontaneous circulation after cardiopulmonary resuscitation (CPR). Methods The patients with CPR restoration of spontaneous circulation who were still in coma were divided into survival group and death group. TCD monitoring and serum NSE detection were performed at 48 hours after CPR restoration of spontaneous circulation. Receiver operating characteristic (ROC) curves were used to evaluate the predictive values of the pulsatility index detected by TCD and serum NES in patients after successful CPR. Results Seventy patients were collected, 32 patients (19 males and 13 females) in the survival group, age 54. 63 ± 13. 28 years; 38 patients (22 males and 16 females) in the death group, age 58. 00 ± 13. 15 years. There were no significant differences in age and gender between the survival and death groups. The pulsatility index was 1. 217 + 0. 352 in the death group, and it was significantly higher than 0.841 +0. 163 in the survival group; the serum NSE content was 130. 968±59.634 ng/ml in the death group, and it was signiflcantly higher than 49. 465 ± 26. 864 ng/ml in the survival gronp (P＜0. 01). When the pulsatility index was used to predict the death of patients, the ROC area under the curve was 0. 794 (P=0. 000,95% confidence interval [CI] O. 679-0. 908);when the cutoff value was 1. 110, the sensitivity was 68.4%, the specificity was 100%,positive predictive value was 100%, and negative predictive value was 72. 7%. When serum NSE level was used to predict the death of the patients, the ROC area under the curve was 0. 756 (P= 0. 000, 95% CI 0. 672-0. 885); when the cutoff value was 56. 502 ng/ml, the sensitivity was 80. 8%, the specificity was 65. 4%, positive predictive value was 82. 5%, and negative predictive value was 76. 6%. Conclusions The pulsatility index detected by TCD and serum NSE content can be used as predictors in patients achieved return of spontaneous circulation after CPR.