超长时心肺复苏成功后患者的特征与预后

目的:回顾分析超长时心肺复苏成功后患者的人口学特征及最终结局.方法:回顾分析1996年1月至2002年12月在我院心跳骤停心肺复苏持续30 min以上、自主循环恢复并维持6 h以上后收入我科ICU进一步救治的病例,共12例,男性10例,女性2例.平均年龄(53.5±19.7)岁.结果:本组12例患者,心肺复苏持续时间的中位数时间为45 min(31～120 min).出院时死亡者(CPC评分5分) 4例,分别死于循环衰竭和多器官功能衰竭;严重脑功能障碍者(CPC评分3分或4分) 3例;痊愈或轻微中枢神经系统缺陷者(CPC评分1分或2分) 5例.年龄和心肺复苏持续时间未显示出与出院结局有显著相关关系(P>0.05).心肺复苏成功后48 h内患者是否清醒与出院结局有非常显著关系(P<0.01).结论:在自主循环建立后,超长时心肺复苏患者的出院结局并不总是很糟糕,应慎重对患者家属或相关人员作出放弃进一步救治的建议.在自主循环建立48 h后对患者出院结局进行预测将更加可靠,对家属作出的建议也更有价值.

Characteristics and outcome of patients after successful prolonged cardiopulmonary resuscitation

Objective:To retrospectively analyze the demographics and the final outcome of patients after successful prolonged cardiopulmonary resuscitation(CPR).Methods:Totally 12 patients, who were admitted to our ICU for further treatment after successful CPR between January 1996 and December 2002, were enrolled into this study.They all had return of spontaneous circulation after prolonged(>30 min) CPR and remained hemodynamically stable for more than 6 h.There were 10 males and 2 females,with a mean age of (53.5±19.7) years.Results:The median duration of BLS/ACLS in the 12 patients was 45 min(range:31-120 min).Four died from circulatory failure and multiple organ failure,3 survived with Cerebral Performance Categories 3 or 4 and 5 with 2 or 1(normal or near normal).There were no significant relation between hospital outcome and age (Spearman's correlation test,P>0.05) and between hospital outcome and duration of CPR attempt (P>0.05).Consciousness within 48 h after return of spontaneous circulation(ROSC) was significantly related with good hospital outcome(Fisher's exact test,P<0.01).Conclusion:The prognosis for patients who achieved spontaneous circulation after prolonged CPR is not necessarily bleak.The advice to give up further resuscitation attempt from the family or related people should be carefully dealt with after ROSC.The prediction of the hospital outcome 48 h later after ROSC is much more accurate and the advice given to the family would be more valuable.