CAJ | 학술논문

目的探讨心源性心搏骤停患者心肺复苏后早期氧摄取率与血乳酸清除率、心输出量(cardiac output,CO)的相关性,并分析其与预后的关系.方法回顾性分析2012年10月至2014年1月在大连医科大学附属第一医院急诊ICU住院期间出现心源性心搏骤停经心肺复苏后自主循环恢复(return of spontaneous circulation,ROSC)并且存活超过6h的14例患者.根据ROSC后72 h是否存活为存活组(n=5)和死亡组(n=9).在入院时(0 h)、ROSC后3、6和12 h分别取动脉血及中心静脉血,检测氧摄取率及血乳酸清除率;同时应用胸阻抗法检测所有患者的CO;进行APACHEⅡ评分,并记录生存时间.结果死亡组患者均死于ROSC后12 ～72 h.与存活组相比,死亡组患者6h和12 h的氧摄取率,3、6和12 h的血乳酸清除率和CO均显著降低(均P＜0.05).ROSC后6h和12 h患者的氧摄取率与乳酸清除率(r=0.857,r=0.947,均P＜0.05)和CO(r=0.968,r=0.936,均P＜0.05)均呈正相关.ROSC后6h和12 h患者的氧摄取率与APACHEⅡ评分呈负相关(r=-0.970,r=-0.973,均P＜0.05);ROSC后3、6和12 h患者的乳酸清除率(r=-0.880,r=-0.899,r=-0.850,均P＜0.05)和CO(r=-0.876,r=-0.922,r=-0.916,均P＜0.05)均与APACHEⅡ呈负相关.结论 ROSC 6 h后的氧摄取率可用于评估心源性心搏骤停患者心肺复苏后病情的严重程度及预后.
목적 탐토심원성심박취정환자심폐복소후조기양섭취솔여혈유산청제솔、심수출량(cardiac output,CO)적상관성,병분석기여예후적관계.방법 회고성분석2012년10월지2014년1월재대련의과대학부속제일의원급진ICU주원기간출현심원성심박취정경심폐복소후자주순배회복(return of spontaneous circulation,ROSC)병차존활초과6h적14례환자.근거ROSC후72 h시부존활위존활조(n=5)화사망조(n=9).재입원시(0 h)、ROSC후3、6화12 h분별취동맥혈급중심정맥혈,검측양섭취솔급혈유산청제솔;동시응용흉조항법검측소유환자적CO;진행APACHEⅡ평분,병기록생존시간.결과 사망조환자균사우ROSC후12 ～72 h.여존활조상비,사망조환자6h화12 h적양섭취솔,3、6화12 h적혈유산청제솔화CO균현저강저(균P＜0.05).ROSC후6h화12 h환자적양섭취솔여유산청제솔(r=0.857,r=0.947,균P＜0.05)화CO(r=0.968,r=0.936,균P＜0.05)균정정상관.ROSC후6h화12 h환자적양섭취솔여APACHEⅡ평분정부상관(r=-0.970,r=-0.973,균P＜0.05);ROSC후3、6화12 h환자적유산청제솔(r=-0.880,r=-0.899,r=-0.850,균P＜0.05)화CO(r=-0.876,r=-0.922,r=-0.916,균P＜0.05)균여APACHEⅡ정부상관.결론 ROSC 6 h후적양섭취솔가용우평고심원성심박취정환자심폐복소후병정적엄중정도급예후.
Objective To investigate the correlation of oxygen extraction rate (ERO2) with blood lactate clearance rate and cardiac output (CO) in the early stage of post-restoration of spontaneous circulation (ROSC) in patients resuscitated from cardiogenic cardiac arrest,and to analyze the relationship between the ERO2 and prognosis.Methods Fourteen patients successfully resuscitated from in-hospital cardiogenic cardiac arrest in the emergency ICU from October 2012 to January 2014 were retrospectively analyzed.These patients were assigned to survival group (n =5) or death group (n =9) as per the outcome at 72 h after ROSC.At admission (0 h),3,6 and 12 h after ROSC,arterial blood and venous blood were drawn to detect ERO2 and lactate clearance rate.Cardiac output (CO) was measured by thoracic impedance method,APACHE Ⅱ scores were assessed,and survival time was recorded.Results The patients in the death group died during the period of 12-72 hours after ROSC.The significantly decreased ERO2 at 6 h and 12 h after ROSC,and decreased blood lactate clearance rate and decreased CO at 3 h,6 h and 12 h after ROSC were found in the death group compared with the survival group (all P ＜ 0.05).The ERO2 at 6 h and 12 h after ROSC was significantly positively related to blood lactate clearance rate (r =0.857,r =0.947,both P ＜ 0.05) and CO (r =0.968,r =0.936,both P ＜ 0.05) at 3 h,6 h and 12 h after ROSC.The ERO2 at 6 h and 12 h after ROSC was significantly negatively related to APPACHE Ⅱ score (r =-0.970,r =-0.973,both P ＜ 0.05);APPACHE Ⅱ scores were significantly negatively correlated with blood lactate clearancerates (r=-0.880,r=-0.899,r=-0.850,all P＜0.05) and CO (r=-0.876,r=-0.922,r=-0.916,all P＜0.05) at 3 h,6 h and 12 h after ROSC.Conclusions The ERO2 at 6h after ROSC may be used to assess the severity and prognosis of patients resuscitated from cardiogenic cardiac arrest.