实用老年医学

实用老年医学 ›› 2021, Vol. 35 ›› Issue (7): 673-675.doi: 10.3969/j.issn.1003-9198.2021.07.003

• 临床研究 • 上一篇    下一篇

早期经颅彩色多普勒超声和APACHEⅡ评分对心肺复苏术后老年病人脑功能复苏预后的评估价值

郭慧, 齐惠军, 吕畅, 李红玲, 贾阳娟, 李建国   

  1. 050051 河北省石家庄市,河北省人民医院急诊科
  • 收稿日期:2020-07-04 出版日期:2021-07-20 发布日期:2021-08-02
  • 通讯作者: 李建国,Email: lijianguo225@126.com
  • 基金资助:
    河北省2019年度医学科学研究课题(20190202)

Value of early transcranial color-coded duplex sonography and APACHE Ⅱ score in evaluating the cerebral functional resuscitation in elderly patients receiving cardiopulmonary resuscitation

GUO Hui, QI Hui-jun, LYU Chang, LI Hong-ling, JIA Yang-juan, LI Jian-guo   

  1. Department of Emergency, Hebei Provincial People’s Hospital, Shijiazhuang 050051, China
  • Received:2020-07-04 Online:2021-07-20 Published:2021-08-02

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摘要： 目的 为指导临床正确评估心肺复苏术后老年病人脑功能复苏情况,探讨早期经颅彩色多普勒超声(TCCD)和APACHEⅡ评分的临床应用价值。 方法 从本院急诊科2016年2月至2019年2月经心肺复苏术抢救成功的心脏骤停老年病人中选取70例病人作为研究对象,并对其临床资料进行回顾性分析,同时参考格拉斯哥-匹兹堡脑功能分级(CPC)将其分为观察组(预后良好组,30例)和对照组(预后不良组,40例)。所有病人均于术后24 h经TCCD测得脑血流并计算APACHEⅡ评分,评估TCCD和APACHEⅡ评分对心肺复苏术后病人脑功能复苏预后的预测价值。 结果 与对照组相比,观察组病人24 h内舒张期末血流速度(Vd)、收缩期峰值血流速度(Vs)、平均峰值血流速度(Vm)均显著增加(P<0.05);观察组病人的大脑中动脉搏动指数和APACHEⅡ评分明显降低(P<0.05)。将心肺复苏术后病人的CPC评分作为标准,绘制心肺复苏术后病人脑血流和APACHEⅡ评分在预测病人脑功能预后的ROC曲线,其中脑血流AUC最佳临界值分别为0.725、5.661,敏感度和特异度分别为66.0%和78.5%;APACHEⅡ评分AUC和最佳临界值分别为0.846、19.43,敏感度和特异度分别为78.6%、79.6%。 结论 心肺复苏成功的早期病人脑血流量会明显增加,而APACHEⅡ评分则会明显降低,这和脑功能复苏预后显著相关。监测上述指标,有利于临床评估病人病情,值得临床推广。

关键词: 心肺复苏, 经颅彩色多普勒超声, 急性生理与慢性健康评分Ⅱ, 脑血流, 预后, 老年人

Abstract: Objective To explore the clinical application value of early transcranial color-coded duplex sonography (TCCD) and acute physiology and chronic health evaluation (APACHE Ⅱ) score to evaluate the cerebral functional recovery after cardiopulmonary resuscitation. Methods A total of 70 patients with cardiac arrest who were successfully rescued by cardiopulmonary resuscitation from February 2017 to February 2019 in our hospital were enrolled in this study, and their clinical data were analyzed retrospectively. The patients were divided into observation group (30 patients with good prognosis) and control group (40 patients with poor prognosis) according to cerebral performance category (CPC). The cerebral blood flow was measured by TCCD, and APACHE Ⅱ score was calculated 24 hours after operation. The value of TCCD and APACHE Ⅱ score in evaluting the prognosis of cerebral functional recovery after cardiopulmonary resuscitation was analyzed. Results Compared with the control group, the end diastolic velocity (VD), peak systolic velocity (VS) and average peak velocity (VM) of the observation group increased significantly within 24 hours; The pulsation index and APACHE Ⅱ score of the middle cerebral artery in the observation group decreased significantly, with significant difference (P<0.05). The receiver operating characteristic (ROC) curves of cerebral blood flow and APACHE Ⅱ score were drawn to predict the prognosis of cerebral function. The results showed that the area under the cerebral blood flow curve and the best critical value was 0.725, 5.661, with a sensitivity and specificity of 66.0% and 78.5%, and the area under APACHE Ⅱ score curve and the best critical value was 0.846, 19.43, with a sensitivity and specificity of 78.6% and 79.6%, respectively. Conclusions In the early stage of cardiopulmonary resuscitation, the cerebral blood flow will increase and APACHE Ⅱ score will decrease significantly, which are associated with the prognosis of cerebral functional resuscitation. Monitoring the above indicators is conducive to clinical evaluation of patients’ condition.

Key words: cardiopulmonary resuscitation, transcranial color-coded duplex sonography, acute physiology and chronic health evaluation Ⅱ, cerebral blood flow, prognosis, aged

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