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目的:探讨心脏骤停心肺复苏(CPR)后脑复苏期间中心静脉血氧饱和度(Sc VO2)和血乳酸水平联合预测其预后的价值。方法:选取心脏骤停CPR后恢复循环但意识不清需行脑复苏患者93例为研究对象。监测患者脑复苏前后的Sc VO2和脑氧供(DO2),并检测同期血乳酸水平和格拉斯哥匹兹堡昏迷评分(GCSP),统计患者生存情况。分析心脏骤停CPR后脑复苏患者Sc VO2和血乳酸水平与其GCSP评分和DO2的关系及心脏骤停CPR后脑复苏期间Sc VO2和血乳酸水平联合预测其预后的价值。结果:93例患者28 d病死率为9.68%,死亡患者脑复苏前后的Sc VO2、DO2和GCSP评分均较存活患者降低,同期血乳酸水平则升高(P<0.05)。与T0比较,死亡患者和存活患者T2、T3和T4的Sc VO2、DO2和GCSP评分均升高,同期血乳酸水平则降低(P<0.05)。心脏骤停CPR后脑复苏患者Sc VO2和血乳酸水平与其DO2和GCSP评分均相关(P<0.05)。且心脏骤停CPR后脑复苏期间Sc VO2和血乳酸水平联合预测其28 d病死率的价值良好。结论:心脏骤停CPR脑复苏患者Sc VO2和血乳酸水平可反映脑氧供和昏迷程度且两者联合预测预后的价值良好,Sc VO2和血乳酸可能作为心脏骤停CPR后脑复苏预后评估的参考指标。
Objective: To investigate the value of predicting the prognosis of central venous oxygen saturation (Sc VO2) and blood lactate levels during cerebral resuscitation after cardiac arrest and cardiopulmonary resuscitation (CPR). Methods: Ninety-three patients with brain-resuscitation were selected as the recovery cycle after CPR. Sc VO2 and DO2 were monitored before and after brain resuscitation. Blood lactate level and Pittsburgh coma scale (GCSP) were measured during the same period. Survival status of patients was calculated. To analyze the relationship between Sc VO2 and blood lactate levels, GCSP score and DO2 in patients with cerebral resuscitation after CPR and the prognosis of patients with cerebral resuscitation after CPR and the combination of Sc VO2 and blood lactate during CPR after cardiac arrest. Results: The mortality of 93 patients was 9.68% at 28 days. The scores of Sc VO2, DO2 and GCSP before and after cerebral resuscitation were lower than those of survivors and the level of blood lactate was increased during the same period (P <0.05). Compared with T0, the Sc VO2, DO2 and GCSP scores of T2 patients, T3 patients and survivors were higher than those of T0 patients at the same time (P <0.05). Sc VO2 and blood lactate levels in patients with CPR after CPR were correlated with DO2 and GCSP scores (P <0.05). And the combined value of Sc VO2 and blood lactate during brain resuscitation after CPR of cardiac arrest predicts a good 28-day mortality. CONCLUSIONS: Sc VO2 and blood lactate levels in CPR patients undergoing cardiac arrest may reflect the degree of cerebral oxygen supply and coma, and their value in predicting prognosis is good. Sc VO2 and blood lactate may be used as reference for assessing the prognosis of cerebral resuscitation after cardiac arrest index.