入住重症监护病房时发生自发性低体温是复苏后患者神经功能不良结局的预测因素：一项观察性队列研究。
Spontaneous hypothermia on intensive care unit admission is a predictor of unfavorable neurological outcome in patients after resuscitation: an observational cohort study.
机构信息
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
出版信息
Crit Care. 2010;14(3):R121. doi: 10.1186/cc9077. Epub 2010 Jun 23.
INTRODUCTION
A large number of patients resuscitated for primary cardiac arrest arrive in the intensive care unit (ICU) with a body temperature < 35.0 degrees C. The aim of this observational cohort study was to determine the association between ICU admission temperature and neurological outcome in this patient group.
METHODS
Demographics and parameters influencing neurological outcome were retrieved from the charts of all patients resuscitated for primary cardiac arrest and treated with induced mild hypothermia in our ICU from January 2006 until January 2008. Patients were divided into two groups according to their body temperature on ICU admission: a hypothermia group (< 35.0 degrees C) and a non-hypothermia group (>or=35.0 degrees C). Neurological outcome after six months was assessed by means of the Glasgow Outcome Score (GOS), with GOS 1 to 3 defined as unfavorable and GOS 4 to 5 as favorable. A logistic regression model was used to analyze the influence of the different parameters on neurological outcome.
RESULTS
The data of 105 consecutive patients resuscitated for primary cardiac arrest and treated with induced mild hypothermia were analyzed. Median ICU admission temperature was 35.1 degrees C (interquartile range (IQR) 34.3 to 35.7). After six months, 61% of the patients had an unfavorable outcome (59% died and 2% were severely disabled), whereas 39% had a favorable outcome (moderate disability or good recovery). Among patients with spontaneous hypothermia on ICU admission, the percentage with unfavorable outcome was higher (69% versus 50%, P = 0.05). Logistic regression showed that age, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores and spontaneous hypothermia on ICU admission all had an increased odds ratio (OR) for an unfavorable outcome after six months. Spontaneous hypothermia had the strongest association with unfavorable outcome (OR 2.6, 95% CI (confidence interval) 1.1 to 5.9), which became even stronger after adjustment for age, presenting heart rhythm, APACHE II and SOFA scores (OR 3.8, CI 1.3 to 11.0).
CONCLUSIONS
In this observational cohort study, spontaneous hypothermia on ICU admission was the strongest predictor of an unfavorable neurological outcome in patients resuscitated for primary cardiac arrest.
简介
大量因原发性心搏骤停而复苏的患者在进入重症监护病房（ICU）时体温<35.0°C。本观察性队列研究的目的是确定该患者群体中 ICU 入院时体温与神经结局之间的关系。
方法
从 2006 年 1 月至 2008 年 1 月在我们的 ICU 接受诱导性轻度低温治疗的所有因原发性心搏骤停而复苏的患者的图表中检索了影响神经结局的人口统计学和参数。根据 ICU 入院时的体温将患者分为两组：低温组（<35.0°C）和非低温组（≥35.0°C）。六个月后的神经结局通过格拉斯哥结局评分（GOS）进行评估，GOS 1 至 3 定义为不良，GOS 4 至 5 定义为良好。使用逻辑回归模型分析不同参数对神经结局的影响。
结果
分析了 105 例因原发性心搏骤停接受诱导性轻度低温治疗的连续患者的数据。中位 ICU 入院时体温为 35.1°C（四分位距 34.3 至 35.7）。六个月后，61%的患者预后不良（59%死亡，2%严重残疾），而 39%的患者预后良好（中度残疾或良好恢复）。在 ICU 入院时出现自发性低温的患者中，预后不良的比例更高（69%比 50%，P=0.05）。逻辑回归显示，年龄、急性生理学和慢性健康评估（APACHE）II 评分和序贯器官衰竭评估（SOFA）评分以及 ICU 入院时的自发性低温均与六个月后的不良预后呈正相关。ICU 入院时出现自发性低温与不良预后的关联最强（OR 2.6，95%CI 1.1 至 5.9），在调整年龄、首发心律失常、APACHE II 和 SOFA 评分后，这种关联甚至更强（OR 3.8，CI 1.3 至 11.0）。
结论
在本观察性队列研究中，ICU 入院时出现自发性低温是原发性心搏骤停复苏患者不良神经结局的最强预测因素。
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