【摘要】：目的：研究心肺復(fù)蘇術(shù)后患者高鐵血紅蛋白(MetHb)水平,探討其與心肺復(fù)蘇術(shù)后患者的病情及早期預(yù)后的關(guān)系。方法：對(duì)廣西醫(yī)科大學(xué)第一附屬醫(yī)院ICU二區(qū)2013年8月至2016年3月期間66例心肺復(fù)蘇術(shù)后患者進(jìn)行回顧性分析。記錄患者的年齡、性別、基礎(chǔ)疾病、心臟驟停原因、心肺復(fù)蘇時(shí)間等臨床資料及入ICU時(shí)的高鐵血紅蛋白水平,同時(shí)記錄患者入ICU 24小時(shí)內(nèi)的急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ (APACHE Ⅱ)評(píng)分、序貫性器官功能衰竭(SOFA)評(píng)分。觀察終點(diǎn)是入ICU第7天的治療結(jié)局。根據(jù)入ICU第7天的治療結(jié)局將患者分為7天死亡組和存活組,比較兩組的高鐵血紅蛋白水平,用雙變量相關(guān)分析評(píng)價(jià)高鐵血紅蛋白與各變量的相關(guān)性,用多因素Logistic回歸、受試者工作特征曲線(ROC曲線)評(píng)價(jià)高鐵血紅蛋白對(duì)心肺復(fù)蘇患者預(yù)后判斷的價(jià)值。結(jié)果：①66例心肺復(fù)蘇患者入選,其中7天生存組32例,死亡組34例,兩組患者的基線資料均衡,具有可比性。②66例患者高鐵血紅蛋白水平(%)0.4-2.8(1.15±0.47),死亡組比存活組高(1.34±0.54 vs 0.94±0.26,P0.01)。③相關(guān)分析顯示,高鐵血紅蛋白水平與SOFA評(píng)分(r=0.449,P0.001)、APACHE Ⅱ評(píng)分(r=0.264,P0.05)、乳酸(r=0.376,P0.001),呈顯著正相關(guān),與PH(r=-0.540,P0.001)、BE(r=-0.477,P0.01)、Hb(r=-0.495,P0.01)顯著負(fù)相關(guān)。④多因素Logistic回.歸分析顯示：BE、高鐵血紅蛋白、乳酸是預(yù)測(cè)心肺復(fù)蘇患者7天死亡風(fēng)險(xiǎn)的獨(dú)立危險(xiǎn)因素,相對(duì)危險(xiǎn)度(OR值)分別為1.175、 1.213、 1.384(P0.05)。⑤ROC曲線分析顯示：高鐵血紅蛋白的ROC曲線下面積為0.748(0.632～0.865),預(yù)測(cè)7天死亡的最佳截?cái)嘀禐?.25%,其敏感度為44.1%,特異性為93.7%。結(jié)論：本研究顯示了升高的高鐵血紅蛋白水平與心肺復(fù)蘇術(shù)后患者病情嚴(yán)重程度和不良預(yù)后之間的相關(guān)性,測(cè)定心肺復(fù)蘇術(shù)后患者的高鐵血紅蛋白水平,可以為早期預(yù)后判斷提供參考。
[Abstract]:Objective: to study the level of methemoglobin (MetHb) in patients after cardiopulmonary resuscitation (CPR) and its relationship with the condition and early prognosis of patients after cardiopulmonary resuscitation (CPR). Methods: 66 patients with cardiopulmonary resuscitation from August 2013 to March 2016 in ICU area II, the first affiliated Hospital of Guangxi Medical University, were analyzed retrospectively. the results showed that 66 patients with cardiopulmonary resuscitation (CPR) were treated with cardiopulmonary resuscitation from August 2013 to March 2016. The clinical data of the patients, such as age, sex, basic disease, causes of cardiac arrest, cardiopulmonary resuscitation time and methemoglobin levels at the time of ICU entry, were recorded. At the same time, acute physiology and chronic health status scoring system II (APACHE 鈪，

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