离子钙水平联合乳酸清除率对心肺复苏后患者近期预后的评估

邹洋洋; 姚莉

doi:10.13201/j.issn.1009-5918.2023.11.004

离子钙水平联合乳酸清除率对心肺复苏后患者近期预后的评估

邹洋洋¹,
姚莉^1, ,

- 合肥市第二人民医院重症医学科(合肥，230011)
基金项目:
合肥市第二人民医院院级课题(No：2021ygkt43)

详细信息

通讯作者: 姚莉，E-mail：2278651164@qq.com

中图分类号: R459.7

收稿日期: 2023-08-10

刊出日期: 2023-11-10

Assessment of ionized calcium levels combined with lactate clearance for the immediate prognosis of patients after cardiopulmonary resuscitation

ZOU Yangyang¹,
YAO Li^1, ,

- Department of Intensive Care Unit, the Second People's Hospital of Hefei, Hefei, 230011, China

More Information

Corresponding author: YAO Li, E-mail: 2278651164@qq.com

Received Date: 10 August 2023

Publish Date: 10 November 2023

摘要

摘要: 目的探讨心肺复苏(cardiopulmonary resuscitation，CPR)后患者早期采用动脉离子钙(ionized calcium，iCa)水平联合乳酸清除率对其近期预后的评估价值。方法回顾性分析合肥市第二人民医院重症医学2018年6月—2020年6月收治的CPR后患者临床资料，包括既往基础疾病、肾上腺素用量、初始乳酸值、iCa水平、乳酸清除率、APACHEⅡ评分，根据CPR后7 d的转归将患者分为存活组和死亡组。采用t/χ²检验比较两组各指标之间差异，并通过建立logistic回归方法分析其与预后的关系，绘制受试者工作曲线(receiver operating curve，ROC)分析对患者预后的判断价值。结果共纳入121例患者，存活组有43例(35.5%)，死亡组有78例(64.5%)；两组的既往疾病、肾上腺素用量、初始乳酸值比较，差异无统计学意义(均P＞0.05)；年龄、入院APACHE Ⅱ评分、iCa及6 h乳酸清除率比较，差异有统计学意义(均P＜0.05)；多因素logistic回归分析显示，APACHEⅡ评分(OR=0.745，95%CI：0.648~0.856)、乳酸清除率(OR=1.100，95%CI：1.050~1.152)、iCa水平(OR=9.184，95%CI：3.196~26.391)是CPR后患者7 d病死率的独立预测因素(均P＜0.05)。iCa、乳酸清除率以及联合两者与APACHEⅡ评分预测概率的曲线下面积分别为0.735(95%CI：0.646~0.827)、0.709(95%CI：0.606~0.811)、0.832(95%CI：0.755~0.910)、0.832(95%CI：0.754~0.910)。结论 iCa水平联合6 h乳酸清除率对CPR后患者近期预后(7 d病死率)具有良好的预测价值。
- 心肺复苏术 /
- 心搏骤停后综合征 /
- 乳酸 /
- 低钙血症 /
- 预后
Abstract: Objective To investigate the value of early use of arterial ionized calcium(iCa) levels combined with lactate clearance in patients after cardiopulmonary resuscitation for the assessment of their immediate prognosis.Methods The clinical data of post-resuscitation patients admitted to the Second People's Hospital of Hefei for critical care medicine from June 2018 to June 2020 were retrospectively analyzed, including previous underlying diseases, epinephrine dosage, initial lactate, iCa level, lactate clearance, and APACHE Ⅱ score, and the patients were divided into survival and death groups according to the regression at 7 d after resuscitation. The t/χ² test was used to compare the indexes in the two groups, and the relationship between them and prognosis were analyzed by establishing a logistic regression method, and the receiver operating curve(ROC curve) was plotted to analyze the value of predicting the prognosis of the patients.Results A total of 121 patients were included, with 43 cases(35.5%) in the survival group and 78 cases(64.5%) in the death group. The differences were not statistically significant when comparing previous disease, epinephrine dosage, and initial lactate between the two groups(all P > 0.05). The differences were statistically significant when comparing age, admission APACHE Ⅱ score, iCa, and 6 h lactate clearance(all P < 0.05). Multivariate logistic regression analysis showed that APACHE Ⅱ score(OR=0.745, 95%CI: 0.648-0.856), lactate clearance rate(OR=1.100, 95%CI: 1.050-1.152), and iCa level(OR=9.184, 95%CI: 3.196-26.391) were independent predictors for 7-d morbidity of post-resuscitation patients(all P < 0.05).The area under the curve of iCa, lactate clearance, combining both and APACHE Ⅱ score were 0.735(95%CI: 0.646-0.827), 0.709(95%CI: 0.606-0.811), 0.832(95%CI: 0.755-0.910) and 0.832(95%CI: 0.754-0.910).Conclusion iCa levels combined with 6 h lactate clearance had good predictive value for the near-term prognosis(7 d morbidity) of patients after cardiopulmonary resuscitation.
- cardiopulmonary resuscitation /
- post cardiac arrest syndrome /
- lactic acid /
- hypocalcemia /
- prognosis

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图 1 iCa、乳酸清除率、APACHEⅡ及联合指标预测心肺复苏后患者7 d病死率的ROC曲线

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表 1 不同预后患者相关影响指标比较 X±S

影响因素	存活组(43例)	死亡组(78例)	t/χ²	P
男性/例(%)	24(55.8)	46(59.0)	0.114	0.736
年龄/岁	61.23±10.76	68.71±12.79	3.248	0.002
既往疾病/例(%)
糖尿病	12(27.9)	19(24.4)	0.183	0.669
高血压	16(37.2)	23(29.5)	0.757	0.384
冠状动脉疾病	12(27.9)	25(32.1)	0.224	0.636
肺气肿	10(23.3)	15(19.2)	0.274	0.601
肾上腺素≤5 mg/例(%)	18(41.9)	36(46.2)	0.207	0.650
APACHEⅡ评分	19.79±5.34	26.21±4.74	6.808	＜0.001
初始乳酸值/(mmol/L)	9.45±3.12	9.67±3.65	0.334	0.739
乳酸清除率/%	59.71±17.24	47.03±13.30	-4.510	＜0.001
iCa/(mg/dL)	4.82±0.83	4.10±0.75	-4.878	＜0.001

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表 2 logistic回归分析心肺复苏后患者7 d病死率的独立预测因素

影响因素	OR	95%CI	Z	P
年龄	0.960	0.905~1.018	-1.37	0.170
APACHE Ⅱ评分	0.745	0.648~0.856	-4.15	＜0.001
乳酸清除率	1.100	1.050~1.152	4.05	＜0.001
iCa	9.184	3.196~26.391	4.12	＜0.001

下载: 导出CSV

表 3 iCa、乳酸清除率、APACHEⅡ及联合对心肺复苏后患者近期预后的评估

影响因素	AUC	标准误	界值	95%CI	灵敏度/%	特异度/%
APACHEⅡ评分	0.832	0.040	23	0.754~0.910	69.77	88.46
乳酸清除率	0.709	0.052	60.78	0.606~0.811	51.16	87.18
iCa	0.735	0.046	4.48	0.646~0.827	67.44	70.51
iCa+乳酸清除率	0.832	0.390	-	0.755~0.910	79.07	76.92

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