Sun Haiwei, Zhu Jianjun, Ma Limei, Lu Juan, Liu Lijun, Zhou Baochun
Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China. Corresponding author: Zhou Baochun, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Sep;33(9):1094-1098. doi: 10.3760/cma.j.cn121430-20210115-00067.
To observe the changes of regional saturation of cerebral oxygenation (rScO) and blood neuron specific enolase (NSE) in patients after cardiopulmonary resuscitation (CPR), and to explore its value in evaluating the prognosis of patients' neurological function.
From January 2012 to December 2020, 97 patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA) treated in the intensive care unit (ICU) of the Second Affiliated Hospital of Soochow University were selected. According to the prognosis, the patients were divided into two groups: good neurological function group [Glasgow-Pittsburgh Cerebral Performance Categories (CPC) 1-2, 20 cases] and neurological dysfunction group (CPC classification 3-5, 77 cases). The clinical data of gender, age, the number of patients with defibrillable rhythm, time of ROSC, the number of CA patients outside the hospital, acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), global non-response scale (FOUR), body temperature, mean arterial pressure (MAP), blood lactic acid (Lac) and GCS at discharge, as well as the length of ICU stay, rScO and blood NSE were collected. The differences of rScO and NSE between the two groups were compared; and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of rScO and NSE alone or in combination in predicting the prognosis of patients with ROSC after CA.
The rScO of good neurological function group was significantly higher than that of neurological dysfunction group at 1, 3, 6, 12, 24 and 48 hours (all P < 0.05). At 24 hours after admission, the rScO on the left and right sides of good neurological function group was significantly higher than that in neurological dysfunction group [left: 0.65 (0.59, 0.76) vs. 0.55 (0.44, 0.67), right: 0.62 (0.61, 0.73) vs. 0.50 (0.30, 0.69), both P < 0.05], and NSE was significantly lower than that in the neurological dysfunction group [ng/L: 21.42 (15.38, 29.69) vs. 45.82 (24.05, 291.26), P < 0.05]. ROC curve analysis showed that both rScO and NSE alone and combined detection had a certain value in predicting the prognosis of neurological function in patients with ROSC after CA, and the area under the ROC curve (AUC) detected by the combination was the largest, which was higher than the AUC predicted by rScO or NSE (0.904 vs. 0.884, 0.792). When the cut-off value of combination was 0.83, the sensitivity and specificity were 75.7% and 100% respectively.
Monitoring rScO and NSE can predict the prognosis of neurological function after CPR, especially the combined evaluation of the two indexes, which can greatly improve the accuracy of diagnosis.
观察心肺复苏（CPR）术后患者脑氧饱和度（rScO）及血神经元特异性烯醇化酶（NSE）的变化，探讨其在评估患者神经功能预后中的价值。
选取2012年1月至2020年12月在苏州大学附属第二医院重症监护病房（ICU）接受治疗的97例心脏骤停（CA）后自主循环恢复（ROSC）的患者。根据预后情况将患者分为两组：神经功能良好组[格拉斯哥-匹兹堡脑功能分类（CPC）1-2级，20例]和神经功能障碍组（CPC分级3-5级，77例）。收集患者的性别、年龄、可除颤心律患者数量、ROSC时间、院外CA患者数量、急性生理与慢性健康状况评分II（APACHE II）、格拉斯哥昏迷量表（GCS）、全面无反应量表（FOUR）、体温、平均动脉压（MAP）、血乳酸（Lac）及出院时GCS，以及ICU住院时间、rScO和血NSE等临床资料。比较两组患者rScO和NSE的差异；绘制受试者工作特征曲线（ROC曲线），评估rScO和NSE单独或联合检测对CA后ROSC患者预后的预测价值。
神经功能良好组在1、3、6、12、24和48小时的rScO均显著高于神经功能障碍组（均P<0.05）。入院24小时时，神经功能良好组左右两侧的rScO均显著高于神经功能障碍组[左侧：0.65（0.59，0.76）对0.55（0.44，0.67），右侧：0.62（0.61，0.73）对0.50（0.30，0.69），均P<0.05]，且NSE显著低于神经功能障碍组[ng/L：21.42（15.38，29.69）对45.82（24.05，291.26），P<0.05]。ROC曲线分析显示，rScO和NSE单独及联合检测在预测CA后ROSC患者神经功能预后方面均有一定价值，联合检测的ROC曲线下面积（AUC）最大，高于rScO或NSE预测的AUC（0.904对0.884、0.792）。当联合检测的截断值为0.83时，灵敏度和特异度分别为75.7%和100%。
监测rScO和NSE可预测CPR术后神经功能预后，尤其是两者联合评估，可大幅提高诊断准确性。
