本文選題：心臟驟停 + 心肺復(fù)蘇�。� 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的：通過對心肺腦復(fù)蘇患者床旁實施TCD、NIRS、頸內(nèi)靜脈球血氧飽和度的監(jiān)測，尋找評估復(fù)蘇后患者神經(jīng)功能損傷程度和預(yù)后的方法和指標(biāo)。 研究方法：收集自2013年08月至2014年03月收入蘇州大學(xué)附屬第二醫(yī)院綜合重癥監(jiān)護病房（ICU）的心臟驟停后恢復(fù)自主循環(huán)的患者。入院后行TCD、NIRS和頸內(nèi)靜脈球血氧飽和度等檢查，同時記錄患者的基本資料。根據(jù)患者ICU出科時的預(yù)后，將患者分為神經(jīng)功能良好組與不良組。分析比較兩組患者臨床特征、腦血流和腦氧代謝等指標(biāo)，探討上述指標(biāo)與患者預(yù)后的關(guān)系，試圖尋找反映腦損傷程度和預(yù)后的良好指標(biāo)。 結(jié)果：1.兩組患者的性別、年齡、基礎(chǔ)疾病、ICU住院時間，初始GCS均無明顯差異（P0.05）；但是，良好組患者心臟驟停至恢復(fù)自主循環(huán)時間（CA-ROSC）和急性生理與慢性健康評分（APACHE II）均有明顯差異（P 0.05）。 2.預(yù)后良好組患者頸內(nèi)靜脈血氧飽（SjvO2）明顯低于不良組患者，差異有統(tǒng)計學(xué)意義（t=-3.579, P 0.05），而兩組之間的rSO2L、rSO2R比較，無明顯差異（P0.05）。預(yù)后良好組患者SjvO2值和左右兩側(cè)腦半球局部腦脈氧飽（r SO2L, r SO2R）均呈正相關(guān)（r=0.738,0.653, P 0.05）；不良組患者SjvO2與r SO2無明顯相關(guān)性（r=0.131,0.214, P0.05）。 3.預(yù)后良好組TCD監(jiān)測的各期血流速度值、腦血流（CBF）高于不良組，而PI、RI值低于不良組，差異均有統(tǒng)計學(xué)意義（P 0.05）。 4.預(yù)后良好組腦氧代謝率（CMRO2）、動靜脈氧含量差（a-vDO2）均高于不良組，，差異有統(tǒng)計學(xué)意義（P 0.05）。 5. ROC曲線分析提示：CMRO2、CBF、a-vDO2、SjvO2、r SO2L、r SO2R可對患者的神經(jīng)功能預(yù)后進行評估，其中CMRO2對評估患者神經(jīng)功能預(yù)后準(zhǔn)確性最高。 結(jié)論：1.對于成人心臟驟�；颊�，其心臟驟停至恢復(fù)自主循環(huán)時間，以及入院后患者APACHE II評分，是影響復(fù)蘇后患者神經(jīng)功能預(yù)后的重要因素。 2.復(fù)蘇后患者頸內(nèi)靜脈球血氧飽和度與局部腦氧飽和度變化一致者，提示患者神經(jīng)功能預(yù)后良好。 3.復(fù)蘇后患者腦氧代謝率、腦血流、動靜脈氧含量差、頸靜脈球血氧飽和度和局部腦脈氧飽和度均與患者的神經(jīng)功能預(yù)后相關(guān)；但是，綜合反映腦組織氧代謝的指標(biāo)—CMRO2能更好評估患者神經(jīng)功能的預(yù)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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R459.7

【參考文獻】

相關(guān)期刊論文 前1條

1 高山;;經(jīng)顱多普勒超聲十年進展[J];中國現(xiàn)代神經(jīng)疾病雜志;2010年01期

本文編號：1859350