摘要
目的 探讨连续监测呼气末二氧化碳分压（PETCO2）对院内心肺复苏（CPR）结果的预测价值,寻找终止CPR的指标.方法 对一项多中心观察研究数据进行二次分析.在研究数据中筛选出复苏30 min内有效记录了PETCO2的成年非创伤院内CPR患者.收集入选患者的临床数据,记录自主循环恢复（ROSC）与非ROSC患者复苏期间的PETCO2均值,并按照1、3、5、8、10 min PETCO2持续≤10 mmHg（1 mmHg=0.133 kPa）对患者复苏结果进行评估.绘制受试者工作特征曲线（ROC）,评估PETCO2≤10 mmHg不同持续时间对复苏结果的预测价值.结果 共入选467例复苏患者,其中419例完成复苏;排除院外复苏、未成年、创伤致心搏骤停、无PETCO2数值、PETCO2数值与临床情况不符和复苏30 min内未监测PETCO2的患者,最终120例成年非创伤院内复苏患者纳入分析.ROSC患者（50例）复苏期间PETCO2均值明显高于非ROSC患者〔70例;mmHg：17（11,27）比9（6,16）,P〈0.01〕.ROC曲线分析显示,复苏期间PETCO2均值预测复苏结果的ROC曲线下面积（AUC）为0.712,95%可信区间（95%CI）为0.689~0.735;当截断值为10.5 mmHg时,敏感度为57.8%,特异度为78.0%,阳性预测值（PPV）为84.6%,阴性预测值（NPV）为46.9%.取各监测点PETCO2≤10 mmHg的持续时间进一步分析显示,随着PETCO2≤10 mmHg持续时间延长,其预测患者复苏失败的敏感度由58.2%降至28.2%,但特异度由39.4%升至100%;PPV由40%升至100%,NPV由57.5%降至34.2%.结论 对于成年非创伤院内复苏患者,PETCO2≤10 mmHg持续10 min可以作为终止复苏的指标.
Objective To approach the predictive value of continuous monitoring end-tidal carbon dioxide partial pressure （PETCO2） on the outcome of in-hospital cardiopulmonary resuscitation （CPR）, and explored the indicators of termination of resuscitation. Methods A secondary analysis of a multicenter observational study data was conducted. The screening aim was adult non-traumatic in-hospital CPR patients whose PETCO2were recorded within 30 minutes of CPR. Clinical information was reviewed. The mean PETCO2in restoration of spontaneous circulation （ROSC） and non-ROSC patients was recorded. The outcome of CPR was continuously assessed by PETCO2≤ 10 mmHg （1 mmHg = 0.133 kPa） for 1, 3, 5, 8, 10 minutes. Receiver operating characteristic （ROC） curve was plotted, and the predictive value of PETCO2≤ 10 mmHg for different duration on the outcome of CPR was evaluated. Results A total of 467 recovery patients, including 419 patients with complete recovery were screened. Patients who were out-of-hospital resuscitation, non-adults, traumatic injury, had no PETCO2value, PETCO2value failed to explained the clinical conditions, or patients had not monitored PETCO2within 30 minutes of resuscitation were excluded, and finally 120 adult patients with non-traumatic in-hospital resuscitation were enrolled in the analysis. The mean PETCO2in 50 patients with ROSC was significantly higher than that of 70 non-ROSC patients [mmHg： 17 （11, 27） vs. 9 （6, 16）, P 〈 0.01]. ROC curve analysis showed that the area under ROC curve （AUC） of PETCO2during the resuscitation for predicting recovery outcome was 0.712 [95% confidence interval （95%CI） = 0.689-0.735]; when the cut-off was 10.5 mmHg, the sensitivity was 57.8%, and the specificity was 78.0%, the positive predictive value （PPV） was 84.6%, and negative predictive value （NPV） was 46.9%. The duration of PETCO2≤ 10 mmHg was used for further analysis, which showed that with PETCO2≤10 mmHg in duration, the prediction of the sensitivity of the patients failed to recover decreased from 58.2% to 28.2%, but specificity increased from 39.4% to 100%; PPV increased from 40% to 100%, and NPV decreased from 57.5% to 34.2%. Conclusion For adult non-traumatic in-hospital CPR patients, continuous 10 minutes PETCO2≤10 mmHg may be an indicate of termination of CPR.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2018年第1期29-33,共5页
Chinese Critical Care Medicine
基金
国家卫生和计划生育委员会公益行业科研专项（201502019）
关键词
心肺复苏
呼气末二氧化碳分压
终止复苏
Cardiopulmonary resuscitation
End-tidal carbon dioxide partial pressure
Termination ofresuscitation
