心脏骤停复苏后患者体温对脑功能预后的影响

摘要

目的：探讨心脏骤停复苏后患者体温与脑功能预后的关系。方法本研究为多中心回顾性队列研究，分析1990年1月1日～2011年12月31日北京市七家三甲医院 ICU 收治的院内心脏骤停后自主循环恢复超过20 min 的患者，收集复苏治疗相关数据和其他临床资料，使用脑功能分级（CPC）评估脑功能结局，分析治疗期间体温与脑功能预后的关系。结果共纳入184例患者，其中68例（37.0％）存活至出院，36例（19.6％）出院时脑功能良好（CPC≤2）。35.5℃＜入 ICU 后第一个24 h 内最高体温＜38.4℃是脑功能预后良好的独立预测因素（OR＝8.986，95％ CI 1.156～69.882；P ＝0.036）。结论对于院内心脏骤停后恢复自主循环的患者，入 ICU 后24 h 内最高体温维持在35.6～38.3℃有利于脑功能预后。%Objective To identify the association between body temperature and neurological outcome in post-arrest patients.Methods This was a multicenter,retrospective cohort study.In the period 1990-2011,a total of 184 patients resuscitated from IHCA with ROSC for more than 20 min were included.Data were collected according to Utstein style.The primary endpoint was hospital dis-charge with good neurological function (Cerebral Performance Category,CPC,1-2).Multivariate Lo-gistic regression was performed to determine the association between body temperature and neurologi-cal outcome.Results Among the 184 enrolled patients,37.0% (68/184)survived to hospital dis-charge,19.6% (36/184)survived to discharge with favorable neurological outcome(CPC,1-2).Mul-tivariate Logistic regression revealed that maximal body temperature between 35.5℃ and 38.4℃ was associated with favorable neurological outcomes (OR=8.986,95% CI 1.156-69.882;P =0.036). Conclusion For IHCA patients achieving spontaneous circulation, maximal body temperature between 35.5℃ and 38.4℃ in the initial 24 h following admission to ICU was associated with favora-ble neurological outcome.