亚低温治疗在心搏骤停心肺复苏后患者中的应用效果分析

摘要

Objective To analyze the application effect of mild hypothermia therapy in sudden cardiac arrest patients undergoing cardio-pulmonary resuscitation (CPR).Methods A total of 102 sudden cardiac arrest patients undergoing CPR were selected in the 175th Hospital of the Chinese People's Liberation Army from March 2013 to June 2017,and they were divided into control group (n =56) and observation group (n =46) according to therapeutic methods.Patients of control group received conventional treatment,while patients of observation group received mild hypothermia therapy based on conventional treatment.Immediate recovery of autonomic circulation tympanic temperature,time to reach the standard tympanic temperature,hemodynamic parameters (including HR,MAP,CVP,CI,GEDVI,SRVI and dPmax) immediate recovery of autonomic circulation,GCS score immediately after CPR,after 12 hours and 24 hours of CPR,NIHSS score before treatment and after 2 weeks of treatment,MMSE score after 2 weeks of treatment were compared between the two groups.Results No statistically significant differences of immediate recovery of autonomic circulation tympanic temperature was found between the two groups (P ＞0.05),while time to reach the standard tympanic temperature of observation group was statistically significantly shorter than that of control group (P ＜ 0.05).No statistically significant differences of MAP,CVP or GEDVI was found between the two groups (P ＞ 0.05),while HR and CI of observation group were statistically significantly lower than those of control group,SVRI and dPmax of observation group were statistically significantly higher than those of control group (P ＜ 0.05).No statistically significant differences of GCS score was found immediately after CPR (P ＞ 0.05),while GCS score of observation group was statistically significantly higher than that of control group after 12 hours and 24 hours of CPR,respectively (P ＜ 0.05).Nostatistically significant differences of NIHSS score was found between the two groups before treatment (P ＞ 0.05),while NIHSS score of observation group was statistically significantly lower than that of control group after 2 weeks of treatment (P ＜ 0.05).After 2 weeks of treatment,directive force score,language competence score,delayed memory ability score,immediate memory ability score,attention and calculation power score,and total MMSE score of observation group were statistically significantly higher than those of control group (P ＜ 0.05).Conclusion Mild hypothermia therapy is helpful to relieve the cerebral damage of sudden cardiac arrest patients undergoing CPR,can effectively improve the neurological function and cognitive function.%目的 分析亚低温治疗在心搏骤停心肺复苏后患者中的应用效果.方法 选取解放军第175医院2013年3月—2017年6月收治的心搏骤停并行心肺复苏成功的患者102例,根据治疗方法分为对照组56例和观察组46例.对照组患者予以常规治疗,观察组患者在对照组基础上予以亚低温治疗.比较两组患者自主循环恢复即刻鼓膜温度、鼓膜温度达标时间及自主循环恢复即刻血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排出量指数(CI)、全心舒张末期容积指数(GEDVI)、外周血管阻力指数(SRVI)、左心室收缩力指数(dPmax)],复苏后即刻及复苏后12、24 h格拉斯哥昏迷量表(GCS)评分,治疗前及治疗2周后美国国立卫生研究院卒中量表(NIHSS)评分,治疗2周后简易精神状态评价量表(MMSE)评分.结果 两组患者自主循环恢复即刻鼓膜温度比较,差异无统计学意义(P＞0.05);观察组患者鼓膜温度达标时间短于对照组(P＜0.05).两组患者自主循环恢复即刻MAP、CVP、GEDVI比较,差异无统计学意义(P＞0.05);观察组患者HR、CI低于对照组,SVRI、dPmax高于对照组(P＜0.05).两组患者复苏后即刻GCS评分比较,差异无统计学意义(P＞0.05);复苏后12、24 h GCS评分高于对照组(P＜0.05).治疗前两组患者NIHSS评分比较,差异无统计学意义(P＞0.05);治疗2周后观察组患者NIHSS评分低于对照组(P＜0.05).治疗2周后观察组患者定向力评分、语言能力评分、延迟记忆能力评分、即刻记忆能力评分、注意力和计算力评分及MMSE总分高于对照组(P＜0.05).结论 亚低温治疗有利于减轻心搏骤停心肺复苏后患者脑损伤,可有效改善患者神经功能及认知功能.