Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungnam National University School of Medicine, 282, Mokdong-ro, Jung-gu, Daejeon, Republic of Korea.
Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
Resuscitation. 2019 Feb;135:118-123. doi: 10.1016/j.resuscitation.2018.10.026. Epub 2018 Oct 26.
We aimed to evaluate the onset of severe blood-brain barrier (BBB) disruption using cerebrospinal fluid/serum albumin quotient (Qa) in cardiac arrest patients treated with target temperature management (TTM).
This was a prospective single-centre observational cohort study from October 2017 to September 2018 with the primary endpoint being the onset of severe BBB disruption, determined based on Qa in cardiac arrest patients treated with TTM. Enrolled patients were grouped according to neurologically good and poor outcomes using the cerebral performance category (CPC) at 3 months after return of spontaneous circulation (ROSC). Severe BBB disruption was evaluated using Qa measured immediately (Qa) and at 24 h (Qa), 48 h (Qa), 72 h (Qa) after ROSC.
Of 21 patients enrolled, poor outcome group had 10 patients. Qa was 0.019 (0.008∼0.024) in the poor outcome group and 0.006 (0.003∼0.008) in the good outcome group (p = 0.09). Qa was 0.045 (0.025∼0.115) in the poor outcome group and 0.006 (0.003∼0.006) in the good outcome group (p = 0.03). Qa was 0.055 (0.023∼0.276) in the poor outcome group and 0.006 (0.006∼0.009) in the good outcome group (p = 0.02). Qa was 0.047 (0.026∼0.431) in the poor outcome group and 0.007 (0.005∼0.011) in the good outcome group (p = 0.02).
Qa was significantly higher in the poor outcome group at 24 h, 48 h, and 72 h. Severe BBB disruption indicated by Qa ≥ 0.02 in poor outcome group treated with TTM occurred within the first 24 h after ROSC.
我们旨在评估目标温度管理（TTM）治疗的心脏骤停患者中，使用脑脊髓液/血清白蛋白比值（Qa）来评估严重血脑屏障（BBB）破坏的发生时间。
这是一项从 2017 年 10 月至 2018 年 9 月进行的前瞻性单中心观察队列研究，主要终点是根据 TTM 治疗的心脏骤停患者的 Qa 确定严重 BBB 破坏的发生时间。根据患者在自主循环恢复（ROSC）后 3 个月的脑功能分类（CPC）分为神经功能良好和不良两组。使用 Qa 评估严重 BBB 破坏，Qa 立即（Qa）、24 小时（Qa）、48 小时（Qa）、72 小时（Qa）后进行测量。
在纳入的 21 名患者中，神经功能不良组有 10 名患者。神经功能不良组的 Qa 为 0.019（0.008∼0.024），神经功能良好组的 Qa 为 0.006（0.003∼0.008）（p=0.09）。神经功能不良组的 Qa 为 0.045（0.025∼0.115），神经功能良好组的 Qa 为 0.006（0.003∼0.006）（p=0.03）。神经功能不良组的 Qa 为 0.055（0.023∼0.276），神经功能良好组的 Qa 为 0.006（0.006∼0.009）（p=0.02）。神经功能不良组的 Qa 为 0.047（0.026∼0.431），神经功能良好组的 Qa 为 0.007（0.005∼0.011）（p=0.02）。
神经功能不良组在 24 小时、48 小时和 72 小时时 Qa 显著升高。在 TTM 治疗的神经功能不良组中，Qa≥0.02 提示严重 BBB 破坏发生在 ROSC 后 24 小时内。
