2020 年第 4 期 第 15 卷

格拉斯哥昏迷量表与APACHEⅡ两种评分方法对心搏骤停后综合征患者神经功能预后预测的对比研究

Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation Ⅱ predicting neurological outcome in patients with post-cardiac arrest syndrome

作者：赵颖超1邓珍华2戴军有3郭欣君4

英文作者：Zhao Yingchao1 Deng Zhenhua2 Dai Junyou3 Guo Xinjun4

单位：1内蒙古自治区人民医院急诊科，呼和浩特010017；2内蒙古自治区人民医院老年病中心，呼和浩特010017；3内蒙古自治区中医医院肾内科，呼和浩特010020；4内蒙古自治区人民医院心内科，呼和浩特010017

英文单位：1Department of Emergency Inner Mongolia People′s Hospital Hohhot 010017 China; 2Geriatric Center Inner Mongolia People′s Hospital Hohhot 010017 China; 3Department of Nephrology Inner Mongolia Autonomous Region Hospital of Traditional Chinese Medicine Hohhot 010020 China; 4Department of Cardiology Inner Mongolia People′s Hopsital Hohhot 010017 China

关键词：心搏骤停后综合征；格拉斯哥昏迷量表；急性生理学与慢性健康状况评分系统Ⅱ；神经功能；预后预测

英文关键词：Post-cardiacarrestsyndrome;GlasgowComaScale;AcutePhysiologyandChronicHealthEvaluationⅡ;Neurologicalfunction;Prognosisprediction

• 摘要：

• 【摘要】目的    比较格拉斯哥昏迷量表（GCS）与APACHEⅡ（急性生理学与慢性健康状况评分系统Ⅱ）两种评分方法对心搏骤停后综合征患者神经功能预后预测的效果。方法    回顾性分析2016年2月至2018年2月内蒙古自治区人民医院收治的150例心搏骤停后综合征患者的病历资料。按照心肺复苏后90 d格拉斯哥-匹兹堡脑功能表现分类将其分为神经功能预后良好组（58例）和神经功能预后不良组（92例）。对比2组患者的机械通气时间、心肺复苏时间、GCS评分以及APACHEⅡ评分。对患者神经功能预后不良的影响因素作Logistic回归分析。采用受试者工作特征（ROC）曲线分析GCS评分和APACHEⅡ评分预测心搏骤停后综合征患者神经功能预后的价值。结果    神经功能预后不良组机械通气时间、心肺复苏时间、APACHE Ⅱ评分明显长于/高于神经功能预后良好组［（8.0±1.6）d比（2.6±0.6）d、（18.2±10.3）min比（8.1±2.1）min、（24±6）分比（18±6）分］，而GCS评分明显低于神经功能预后良好组［（4.6±1.6）分比（15.4±3.3）分］，差异均有统计学意义（均P＜0.05）。经多因素Logistic回归分析可得，机械通气时间、心肺复苏时间、APACHEⅡ评分均是心搏骤停后综合征患者神经功能预后不良的独立危险因素，而GCS评分是其保护因素（均P＜0.05）。经ROC曲线分析可得，GCS评分预测心搏骤停后综合征患者神经功能预后的曲线下面积、敏感度、特异度相比APACHEⅡ评分均较高（0.947比0.825、0.976比0.843、0.928比0.801）。结论    GCS评分对心搏骤停后综合征患者神经功能预后预测的价值明显高于APACHEⅡ评分。

• 【Abstract】Objective    To analyze the values of Glasgow Coma Scale(GCS) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) for prognosis of neural function in patients with post-cardiac arrest syndrome. Methods    Clinical data of 150 patients with post-cardiac arrest syndrome admitted to Inner Mongolia People′s Hospital from February 2016 to February 2018 were retrospectively analyzed. According to the Glasgow-Pittsburgh classification of brain function 90 d after cardiopulmonary resuscitation, the patients were divided into good neural outcome group（58 cases） and poor neural outcome group（92 cases）. Mechanical ventilation time, cardiopulmonary resuscitation time, GCS score and APACHE Ⅱ score were recorded. Influence factors of neurological outcome were analyzed by logistic regression. Predictive values of GCS score and APACHEⅡ score for neurological outcome were analyzed by receiver operating characteristic（ROC） curve. Results    The poor neural outcome group had longer mechanical ventilation time and cardiopulmonary resuscitation time, higher APACHE Ⅱ score and lower GCS score than the good neural function group; the differences were statistically significant［（8.0±1.6）d vs （2.6±0.6）d, （18.2±10.3）min vs （8.1±2.1）min, （24±6） vs （18±6）, （4.6±1.6） vs （15.4±3.3）］(all P ＜ 0.05). Multivariate logistic regression analysis showed that mechanical ventilation time, cardiopulmonary resuscitation time and APACHE Ⅱ score were independent risk factors of poor neural outcome, and GCS score was a protective factor(all P＜0.05). ROC curve analysis showed that GCS score was associated with larger area under the curve, higher sensitivity and specificity in predicting the prognosis of neural function than APACHEⅡ score（0.947 vs 0.825, 0.976 vs 0.843, 0.928 vs 0.801）. Conclusion    GCS is more effective than APACHE Ⅱ in predicting neurological outcome in patients with post-cardiac arrest syndrome.