脑功能监测对心肺复苏后患者神经功能预后的评估

发布时间：2018-05-08 01:24

本文选题：心脏骤停 + 心肺复苏　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：通过对心肺脑复苏患者床旁实施TCD、NIRS、颈内静脉球血氧饱和度的监测，寻找评估复苏后患者神经功能损伤程度和预后的方法和指标。研究方法：收集自2013年08月至2014年03月收入苏州大学附属第二医院综合重症监护病房（ICU）的心脏骤停后恢复自主循环的患者。入院后行TCD、NIRS和颈内静脉球血氧饱和度等检查，同时记录患者的基本资料。根据患者ICU出科时的预后，将患者分为神经功能良好组与不良组。分析比较两组患者临床特征、脑血流和脑氧代谢等指标，探讨上述指标与患者预后的关系，试图寻找反映脑损伤程度和预后的良好指标。结果：1.两组患者的性别、年龄、基础疾病、ICU住院时间，初始GCS均无明显差异（P0.05）；但是，良好组患者心脏骤停至恢复自主循环时间（CA-ROSC）和急性生理与慢性健康评分（APACHE II）均有明显差异（P 0.05）。 2.预后良好组患者颈内静脉血氧饱（SjvO2）明显低于不良组患者，差异有统计学意义（t=-3.579, P 0.05），而两组之间的rSO2L、rSO2R比较，无明显差异（P0.05）。预后良好组患者SjvO2值和左右两侧脑半球局部脑脉氧饱（r SO2L, r SO2R）均呈正相关（r=0.738,0.653, P 0.05）；不良组患者SjvO2与r SO2无明显相关性（r=0.131,0.214, P0.05）。 3.预后良好组TCD监测的各期血流速度值、脑血流（CBF）高于不良组，而PI、RI值低于不良组，差异均有统计学意义（P 0.05）。 4.预后良好组脑氧代谢率（CMRO2）、动静脉氧含量差（a-vDO2）均高于不良组，，差异有统计学意义（P 0.05）。 5. ROC曲线分析提示：CMRO2、CBF、a-vDO2、SjvO2、r SO2L、r SO2R可对患者的神经功能预后进行评估，其中CMRO2对评估患者神经功能预后准确性最高。结论：1.对于成人心脏骤停患者，其心脏骤停至恢复自主循环时间，以及入院后患者APACHE II评分，是影响复苏后患者神经功能预后的重要因素。 2.复苏后患者颈内静脉球血氧饱和度与局部脑氧饱和度变化一致者，提示患者神经功能预后良好。 3.复苏后患者脑氧代谢率、脑血流、动静脉氧含量差、颈静脉球血氧饱和度和局部脑脉氧饱和度均与患者的神经功能预后相关；但是，综合反映脑组织氧代谢的指标—CMRO2能更好评估患者神经功能的预后。
[Abstract]:Objective: to evaluate the degree of nerve function injury and prognosis of patients with cardiopulmonary cerebral resuscitation (CPR) by monitoring the blood oxygen saturation of jugular jugular bulb and TCDN NIRS. Methods: from August 2013 to March 2014, patients admitted to ICU (General intensive Care Unit, second affiliated Hospital of Suzhou University) recovered their autonomic circulation after cardiac arrest. After admission, TCDN NIRS and jugular bulb oxygen saturation were performed, and basic data were recorded. According to the prognosis of ICU, the patients were divided into two groups: good nerve function group and bad group. The clinical characteristics, cerebral blood flow and cerebral oxygen metabolism were analyzed and compared between the two groups. The relationship between the above indexes and the prognosis of the patients was discussed, and a good index to reflect the degree of brain injury and prognosis was sought. The result is 1: 1. There was no significant difference in sex, age, hospitalization time and initial GCS between the two groups, but there were significant differences in CA-ROSCand acute physiological and chronic health scores between the two groups (P 0.05). 2. SjvO2 of jugular vein in the group with good prognosis was significantly lower than that in the group with poor prognosis (P < 0.05). The difference was statistically significant (P < 0.05). However, there was no significant difference between the two groups in terms of rSO2LnrSO2R. The SjvO2 values of patients with good prognosis were positively correlated with the regional cerebral hemispheric oxygen saturation (RSO _ 2L, r so _ 2R) in the left and right hemispheres (P < 0.05), but there was no significant correlation between SjvO2 and r SO2 in the poor group (P < 0.05). 3. The blood flow velocities monitored by TCD in the good prognosis group were higher than those in the bad group, but the Pi RI value was lower than that in the bad group, and the difference was statistically significant (P 0.05). 4. The cerebral oxygen metabolism rate and arteriovenous oxygen content difference in the good prognosis group were higher than those in the poor group (P 0.05). 5. The analysis of ROC curve showed that the CMRO2 SO2R could evaluate the prognosis of neurologic function of the patients with CBFO ~ (a-vDO2) SjvO _ (2) O _ (2) r so _ (2L) SO2R, and CMRO2 was the most accurate in evaluating the prognosis of the patients' neurological function. Conclusion 1. For adult patients with cardiac arrest, the time from cardiac arrest to recovery of autonomic circulation and the APACHE II score of patients after admission are important factors affecting the prognosis of neurological function after resuscitation. 2. The changes of oxygen saturation of jugular bulb and local cerebral oxygen saturation were consistent after resuscitation, which indicated that the prognosis of the patients with neurologic function was good. 3. After resuscitation, cerebral oxygen metabolism rate, cerebral blood flow, arteriovenous oxygen content, jugular bulb oxygen saturation and local cerebral venous oxygen saturation were all related to the prognosis of neurologic function. The comprehensive index of cerebral oxygen metabolism-CMRO2 can better evaluate the prognosis of patients with neurological function.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R459.7

【参考文献】