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平均动脉压与心肺复苏后存活患者的神经功能有关:一项回顾性队列研究。

Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study.

机构信息

Rehabilitation Medicine Department, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China.

Rehabilitation Medicine Department, The First Affiliated Hospital of Southwest Medical University, Luzhou, China.

出版信息

Clin Cardiol. 2020 Nov;43(11):1286-1293. doi: 10.1002/clc.23441. Epub 2020 Aug 1.

DOI:10.1002/clc.23441
PMID:32737997
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7661647/
Abstract

BACKGROUND

About 18% to 40% of the survivors have moderate to severe neurological dysfunction. At present, studies on mean arterial pressure (MAP) and neurological function of patients survived after cardiopulmonary resuscitation (CPR) are limited and conflicted.

HYPOTHESIS

The higher the MAP of the patient who survived after CPR, the better the neurological function.

METHOD

A retrospective cohort study was conducted to detect the relationship between MAP and the neurological function of patients who survived after CPR by univariate analysis, multivariate regression analysis, and subgroup analysis.

RESULTS

From January 2007 to December 2015, a total of 290 cases met the inclusion criteria and were enrolled in this study. The univariate analysis showed that MAP was associated with the neurological function of patients who survived after CPR; its OR value was 1.03 (1.01, 1.04). The multi-factor regression analysis also showed that MAP was associated with the neurological function of patients survived after CPR in the four models, the adjusted OR value of the four models were 1.021 (1.008, 1.035); 1.028 (1.013, 1.043); 1.027 (1.012, 1.043); and 1.029 (1.014, 1.044), respectively. The subgroups analyses showed that when 65 mm Hg ≤ MAP<100 mm Hg and when patients with targeted temperature management or without extracorporeal membrane oxygenation, with the increase of MAP, the better neurological function of patients survived after CPR.

CONCLUSION

This study found that the higher MAP, the better the neurological function of patients who survived after CPR. At the same time, the maintenance of MAP at 65 to 100 mm Hg would improve the neurological function of patients who survived after CPR.

摘要

背景

约 18%至 40%的幸存者存在中度至重度神经功能障碍。目前,心肺复苏(CPR)后存活患者的平均动脉压(MAP)与神经功能的研究有限且存在冲突。

假说

CPR 后存活患者的 MAP 越高,神经功能越好。

方法

采用回顾性队列研究,通过单因素分析、多因素回归分析和亚组分析,检测 MAP 与 CPR 后存活患者神经功能的关系。

结果

2007 年 1 月至 2015 年 12 月,共纳入符合条件的 290 例患者。单因素分析显示,MAP 与 CPR 后存活患者的神经功能有关,其 OR 值为 1.03(1.01,1.04)。多因素回归分析也显示,MAP 与 CPR 后存活患者的神经功能在四个模型中均相关,四个模型的调整 OR 值分别为 1.021(1.008,1.035);1.028(1.013,1.043);1.027(1.012,1.043);和 1.029(1.014,1.044)。亚组分析显示,当 65mmHg≤MAP<100mmHg 且患者接受目标温度管理或未接受体外膜氧合时,随着 MAP 的增加,CPR 后存活患者的神经功能越好。

结论

本研究发现,MAP 越高,CPR 后存活患者的神经功能越好。同时,维持 MAP 在 65 至 100mmHg 可改善 CPR 后存活患者的神经功能。

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