神经元特异性烯醇化酶和S100蛋白评估心脏停搏患者复苏后脑损伤的研究

目的观察血清神经元特异性烯醇化酶（NSE）和S100蛋白水平对心脏停搏（CA）患者心肺复苏（CPR）后脑损伤预后评估的价值。方法将25例CPR患者根据6个月时是否恢复意识分为两组。检测患者在自主循环恢复（ROSC）后2、12、24、48和72h的血清NSE和S100蛋白水平，分析两组在不同时间点NSE和S100蛋白水平之间的差异，并与健康对照组进行比较。描绘两种诊断方法的受试者工作特征曲线（ROC曲线）并计算曲线下面积进行分析。结果①意识未恢复组血清NSE水平在ROSC后12、48和72h，S100蛋白水平在ROSC后2、12、48和72h均明显高于意识恢复组（P均〈0．01）。②意识恢复组12h和24h的NSE水平与12h的S100蛋白水平均较健康对照组高（P均〈0．05）；而意识未恢复组各时间点的NSE水平及12、48和72h的S100蛋白水平均较健康对照组增高显著（P〈0．05或P〈0．01）。③血清NSE和S100蛋白两种诊断方法曲线下面积分别为0．848（P=0．000）和0．896（P=0．000），对判断CA患者CPR后能否恢复意识具有较高的诊断意义。S100蛋白以0．165μg／L为临界值，ROSC后2h其敏感度、特异度、阳性预告率、阴性预告率及准确率最高，分别为94．4％、100．0％、100．0％、80．0％和95．5％,NSE以45．6μg／L为临界值，则以ROSC后48h各指标最满意，均达到100．0％。结论血清NSE和S100蛋白水平对评价CPR后患者的脑损伤程度及能否恢复意识具有诊断意义，两者联合动态观察，对严重而持续的脑损伤更有诊断价值。     

心肺复苏不同预后患者血清细胞因子变化及意义

目的探讨心肺复苏（CPR）不同预后患者血清细胞因子动态变化及意义。方法将19例CPR自主循环恢复（ROSC）患者分为复苏失败组（A1组）14例和存活出院组（A2组）5例，10例死亡者做对照组（B组），用ELISA法检测CPR时、ROSC24h、48h、72h、7d患者血清TNF—α、IL-1β、IL-4、IL-8、IL-10水平变化。结果B组CPR时TNF—α含量高于A1、A2组（P〈0．05），IL-1β、IL-4、IL-8、IL-10水平三组间差异无统计学意义（均P〉0．05）。A1组复苏后MODS发病率高于A1组A2／14vs1／5，P=0．016），ROSC24hTNF—α、IL—1β水平高于其CPR时和A2组（P〈0．05），ROSC48hTNF—α、IL-1β、IL-8水平达峰值，且高于A2组，IL-4、IL-10水平高于其CPR时（均P〈0.05），与A2组差异无统计学意义（P〉0.05），ROSC72hTNF—α、IL-1β水平下降，IL-4高于A，组（P〈0.05）。结论细胞因子异常释放参与复苏后缺血一再灌注损伤病理过程，选择时机干预其失衡，可能改善复苏预后.     

氢气减轻家兔心搏骤停后脑损伤

目的 探讨氢气(hydrogen,H2)干预对心搏骤停后脑损伤的作用.方法 实验在厦门大学动物实验中心进行,新西兰白兔60只,随机(随机数字法)分为2组:A组为2％氢气干预,B组为空气对照.比较血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、神经元特异性烯醇化酶( neuron-specific enolase,NSE)、S100β蛋白质量浓度及神经功能缺损评分(neurological deficit scores,NDS)变化,分析全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)诊断数和兔存活数的差异.结果 A、B两组兔自主循环恢复(restoration of spontaneous circulation,ROSC)数量接近,随着时间延长,存活兔减少,到ROSC 72 h时,A组兔存活数高于B组(x2=4.850,P＜0.05).心肺复苏(cardiopulmonary resuscitation,CPR)后B组血中H2质量浓度于ROSC 4 h达峰值后下降;A组H2浓度保持在较高水平上.在ROSC后,两组兔均有不同程度炎症反应发生,ROSC 24 h时,A组TNF-α质量浓度、SIRS诊断数低于B组(P＜0.05).两组血清NSE和S100β质量浓度在CPR后升高,分别于ROSC 24 h和4h达峰值后下降,A组峰值低于B组(P＜0.05).两组兔在CPR后NDS分值逐渐下降,ROSC 72 h时,A组NDS低于B组(t=-2.689,P=0.013).结论 H2能抑制CPR后炎症反应,减轻心搏骤停后脑损伤.     

乌司他丁对大鼠心肺复苏后早期血清S-100B蛋白和NSE的影响

目的 探讨乌司他丁(UTI)对大鼠心肺复苏(CPR)后早期血清S-100B蛋白、神经元特异性烯醇化酶(NSE)及海马病理改变的影响及作用.方法 成年雄性SD大鼠随机分为假手术对照组、复苏组和UTI组,每组10只.采用窒息法致复苏组和UTI组大鼠心脏骤停(CA),继而进行心肺复苏(CPR).UTI组于自主循环恢复(ROSC)后2 min内经颈动脉推注注射用UTI 100 000 U/kg,与生理盐水配伍成2 mL溶液.对照组仅行麻醉、气管切开和血管穿刺.复苏组和UTI组于ROSC后1 h,对照组于气管切开后1 h经颈动脉取血和快速断头取左侧脑海马组织.采用双抗体夹心酶联免疫吸附法(ELISA)分别检测血清S-100B蛋白与NSE水平;光镜下观察海马的病理改变.结果 与假手术对照组比较,复苏组和UTI组大鼠血清S-100B蛋白与NSE浓度在ROSC后1 h均明显升高(P<0.01);与复苏组比较,UTI组大鼠血清S-100B蛋白浓度显著降低(P<0.01),而NSE的浓度降低不明显(P>0.05).UTI组病理损害轻于复苏组.结论 UTI能降低大鼠CPR后早期(1 h)血清S-100B蛋白和NSE水平,减轻病理损伤,对CPR过程中的脑组织具有保护作用.     

可溶性P-选择素、血小板激活因子与心肺复苏的关系探讨

目的 探讨可溶性P－选择素、血小板激活因子（PAF）能否成为恢复自主循环（ROSC＋）及其后全身炎性反应综合征（SIRS）与脓毒血症评定的标准。方法 将心肺复苏（CPR）组60例分为ROSC＋组25例和未恢复自主循环（ROSC－）组35例。ROSC＋组又分为SIRS15例、非SIRS9例，24－48h存活1例，脓毒血症13例、非脓毒血症11例。各组血标本获取时间是：ROSC＋组分别于心跳骤停（CA）时、ROSC＋后、ROSC＋48h后；ROSC－组分别在CA时、CPR失败后；脓毒血症患者和非脓毒血症患者在ROSC＋48h后；以上血标本分别测血浆P－选择素及PAF浓度，此外动态观察ROSC＋组TNF－α。凝血酶原时处理同复苏组。结果 CPR组PT、APTT明显短于对照组（P＜0．05）；SFMC呈阳性（P＜0．01）；CA时、CPR后P－选择素、PAF、TNF－α明显高于对照组（P＜0．05、P＜0．01）。ROSC－组患者CA时、CPR后P－选择素、PAF分别较ROSC＋组患者浓度高（P＞0．05）。SIRS组、脓毒血症组P－选择素、PAF、TNF－α分别高于非SIRS组、非脓毒血症组及对照组（P＜0．01。结论 可溶性P－选择素、PAF、TNF－α可预测SIRS及脓毒血症的发生，但不能作为评定ROSC＋的标准     

心脏骤停患者心肺复苏自主循环恢复预后相关因素分析

目的：探究心脏骤停（CA）患者心肺复苏（CPR）自主循环恢复后（ROSC）预后的相关因素,为提高CPR成功率提供临床经验。方法：回顾性分析广东省梅州市人民医院2018年1月到2021年2月525例CPR患者的基线资料、入院信息、CPR信息、治疗情况和结局。结果：以ROSC分组并建立Logistic回归模型,未ROSC组CPR持续时间高于ROSC组（34.39±11.56 min vs 18.59±16.66 min,P<0.001）;CPR所致胸部损伤OR值0.277(95%CI:0.115-0.670)）和CPR持续时间OR值0.006(95%CI:0.002-0.017)可能是ROSC的独立影响因素。以出院状态分组并建立Logistic回归模型,存活出院组CPR持续时间高于非存活出院组（22.08±19.10 min vs 15.86±14.05 min,P=0.041）;以“非存活出院”为参考状态,CPR持续时间、CPR所致胸部损伤和入院时间可能是患者存活出院的影响因素,OR值分别为0.951(95%CI:0.915-0.988),4.457(95%CI:1.297-15....     

院前心脏骤停患者心肺复苏成功相关影响因素分析

目的分析影响急诊科心肺复苏（CPR）成功的因素,并寻找影响自主循环恢复（ROSC）的独立影响因素。方法以2009年3月至2012年5月院前发生的240例心脏骤停（CA）患者为研究对象,比较ROSC组和Non—ROSC组的CPR开始时间、CPR持续时间、除颤次数和。肾上腺素用量等。结果全部病例ROSC成功率为42．08％,脑复苏成功率仅为3．33％。两组在年龄、性别、CPR持续时间、除颤次数上比较差异无统计学意义（P〉0．05）,在开始CPR时间、气管插管时间、肾上腺素累计用量方面比较差异有统计学意义（P〈0．01）;影响CA患者ROSC的因素有心室纤颤、无脉搏电活动、电除颤次数、肾上腺素累积剂量以及CA绝对时间。结论CPR成功率与开始CPR时间和人工气道建立的早晚有密切关系。CA绝对时间、除颤、肾上腺素累积剂量是CA患者ROSC的独立影响因素。     

血清S-100B蛋白联合NSE水平对新生儿缺氧缺血性脑病的预后评估价值

目的探讨血清S-100B蛋白联合神经元特异性烯醇化酶(NSE)水平对新生儿缺氧缺血性脑病(HIE)的预后评估价值。方法选取该院收治的HIE患儿118例,根据其预后情况分为存活组(n=88)和死亡组(n=30)。采用神经症状临床分度分为轻中度组(n=82)和重度组(n=36),比较各组第1、3、5天血清S-100B蛋白及NSE水平变化。应用受试者工作特征曲线(ROC曲线)分析血清S-100B蛋白及NSE水平预测HIE患儿死亡的价值。结果死亡组第1、3、5天血清S-100B蛋白及NSE水平均明显高于存活组,且死亡组血清S-100B蛋白及NSE水平呈升高趋势(P<0.05)。重度组第1、3、5天血清S-100B蛋白及NSE水平均明显高于轻中度组,且重度组血清S-100B蛋白及NSE水平呈升高趋势(P<0.05)。ROC曲线显示,第3天血清S-100B蛋白联合NSE水平预测HIE患儿死亡的ROC曲线下面积最大为0.950(95%CI 0.892~0.997),其灵敏度和特异度分别为95.2%和89.6%。相关分析显示,死亡组血清S-100B蛋白与NSE水平呈正相关(r=0.817,P<0.01)。结论血清S-100B蛋白与NSE水平与HIE患儿的病情严重程度相关,第3天两项指标联合预测HIE患儿预后的价值较高。     

心肺复苏后大鼠血清神经元特异性烯醇化酶、S100β蛋白对脑损伤诊断的价值

目的观察大鼠心肺复苏后血清神经元特异性烯醇化酶(NSE)和S100β蛋白水平变化,确立CPR后脑损伤具有早期诊断价值的生化指标。方法选择成年雄性Sprague-Dawley大鼠50只,采用窒息合并冰氯化钾停跳液制备大鼠心跳骤停-心肺复苏模型。随机分为5组:对照组即假手术组10只,自主循环恢复(ROSC)后6、12、24、48h组各10只。停跳5min后开始心肺复苏,采用双抗体夹心酶联免疫分析法为对照组及ROSC后6、12、24、48h组进行动态观测血清中NSE、S100β蛋白水平变化。结果在ROSC后6、12、24、48h组的血液中NSE、S100β蛋白水平与对照组比较都有显著升高(P<0.05),但指标升高的时间和幅度并不一致。与对照组比较,血清NSE在24h时点、S100β蛋白在6h时点升高水平差异有极其显著性(P<0.01)。结论血清NSE、S100β蛋白水平可作为评价CPR后脑损伤具有早期诊断价值的指标。     

心肺复苏后多器官功能障碍综合征临床分析

目的通过分析心肺复苏（CPR）后机体并发多器官功能障碍综合征（MODS）情况及其与自主循环恢复（ROSC）时间的关系，以期发现影响复苏患者预后的因素。方法回顾我院急诊科自1998—05～2004—12成功CPR的33例患者，按ROSC时间将复苏患者分为0～5min组（10例）、5～15min组（7例）及15～45min组（16例）。统计分析复苏患者ROSC不同时间受损脏器的发生率、分布、脏器受损程度构成比及复苏患者ROSC时间与并发MODS之间的关系。结果33例复苏成功患者均有不同程度脏器损伤，复苏后心脑肺最易受损，单个复苏患者受损脏器最多8个；ROSC时间不同的三组患者脏器受损率有显著差别（P〈0．01），其中0～5min组患者脏器受损发生率显著低于5～15min组及15～45min组的患者（P〈0．01），后两组患者脏器受损率无明显差别（P〉0．05）；ROSC时间不同的三组患者脏器受损程度构成分布明显不同（P〈0．01）；复苏患者ROSC时间与脏器受损程度呈显著正相关（P〈0．01）。结论复苏患者应争取尽早恢复自主循环，减少受损脏器例数及减轻脏器受损程度；复苏后重点是心脑肺的保护；对猝死的非终末期患者，即使复苏时间较长仍不要轻易放弃抢救，复苏后多个脏器受损的患者仍有望治愈。     

神经元烯醇化酶和脑电双频指数评估心肺复苏患者预后

目的：探讨神经元特异度烯醇化酶和脑电双频指数对心肺复苏成功后接受亚低温治疗患者预后的评估价值。方法选择心搏骤停复苏成功自主循环恢复后的昏迷患者46例,所有患者均接受亚低温治疗,测定自主循环恢复后24、48、72 h患者血清神经元特异度烯醇化酶和脑电双频指数。3个月后进行大脑功能评分（ cerebral-performance category CPC）, CPC1-3分,为预后良好, CPC 4-5分,为预后不良。结果3个月后,预后良好（CPC1-3分）14例,预后不良（CPC4-5分）32例,预后不良组患者48、72 h血清NSE水平高于预后良好组[48 h：（90.1±42.7） ng／mL vs ．（33.2±17.5） ng／mL;72 h：（95.4±37.0） ng／mL vs．（29.2±17.0） ng／mL, P＜0.05]。预后不良组患者NSE在48h和72h均出现升高趋势,而预后良好组均出现降低趋势[△NSE 24 h-48 h：（37.3±28.7） ng／mL vs．（-10.7±12.1） ng／mL;△NSE 48 h-72h：（5.3±13.2） ng／mL vs．（-4.0±4.5） ng／mL, P＜0.05],两组变化出现显著性差异。预后不良组48、72 h BIS值低于预后良好组[48h：（39.2±24.1） vs．（78.0±12.4）;72 h：（45.7±26.4） vs．（89.0±7.3）, P＜0.05]。结论神经元特异度烯醇化酶（NSE）和脑电双频指数（ BIS ）可评估接受亚低温治疗的心搏骤停后患者的神经功能预后,为临床决策提供依据。     

Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study

OBJECTIVE: The aim of this study was to investigate whether serial serum neuron-specific enolase (NSE) can be used to predict neurological prognosis in patients remaining comatose after cardiopulmonary resuscitation (CPR). DESIGN. Observational cohort study. Clinicians were blinded to NSE results. SETTING: Eighteen-bed general ICU. PATIENTS: Comatose patients admitted to the ICU after CPR. INTERVENTIONS: Serum NSE was measured at admission and daily for 5 days. MEASUREMENTS AND RESULTS: Patients received full intensive treatment until recovery or until absence of cortical response to somatosensory evoked potentials more than 48 h after CPR proved irreversible coma. Of the 110 patients included (mean GCS at ICU admission 3, range 3--9), 34 regained consciousness, five of whom died in hospital. Seventy-six patients did not regain consciousness, 72 of whom died in hospital. Serum NSE at 24 h and at 48 h after CPR was significantly higher in patients who did not regain consciousness than in patients who regained consciousness (at 24 h: median NSE 29.9 microg/l, range 1.8-250 vs 9.9 microg/l, range 4.5-21.5, P<0.001; at 48 h: median 37.8 microg/l, range 4.4-411 vs 9.5 microg/l, range 6.2-22.4, P= 0.001). No patient with a serum NSE level >25.0 microg/l at any time regained consciousness. Addition of NSE to GCS and somatosensory evoked potentials increased predictability of poor neurological outcome from 64% to 76%. CONCLUSIONS: High serum NSE levels in comatose patients at 24 h and 48 h after CPR predict a poor neurological outcome. Addition of NSE to GCS and somatosensory evoked potentials increases predictability of neurological outcome.     

Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale

BACKGROUND AND PURPOSE: Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers and two neuroproteins, neuron-specific enolase (NSE) and S-100 protein (S-100), in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002. RESULTS: 52.6% of the patients died, 28.8% survived with severe, moderate or without neurological disorders, and 18.6% remained in a persistent vegetative state. Unconsciousness>48 h after CPR predicted a 60.6-fold (95% CI 14.3287-257.205, p=0.001) and a Glasgow Coma Scale (GCS)<6 points after 72 h a 11.2-fold (CI 95%, 3.55-36.44, p<0.001) risk of poor neurological outcome. Serum levels>or=65 ng/ml for NSE and >or=1.5 microg/l for S-100 increased the risk of death and persistent vegetative state 16.8 (95% CI 2.146-131.520)- and 12.6 (95% CI 1.1093-99.210)-fold, respectively. By combination of the GCS with elevated serum concentrations of both neuroproteins above the cut off levels on third day after CPR a poor neurological outcome was predicted with a specificity of 100%. CONCLUSION: The combination of GCS with the serum levels of both neuroproteins at 72 h after CPR permit a more reliable prediction of outcome in post arrest coma than the single markers alone, independent of the application of anaesthetic agents.     

Significant factors in predicting sustained ROSC in paediatric patients with traumatic out-of-hospital cardiac arrest admitted to the emergency department

BACKGROUND: Paediatric patients with out-of-hospital cardiac arrest (OHCA) due to trauma pose difficult challenges in resuscitation. Trauma is a major cause of OHCA in children. The aim of this study was to determine which factors were related to predicting a sustained return of spontaneous circulation (ROSC) in paediatric OHCA patients with trauma. METHOD: This retrospective study comprised 115 paediatric patients (56 traumatic and 59 non-traumatic OHCA patients) aged younger than 18 years who had been admitted to the emergency department (ED) from January 2000 to December 2004. We analysed the demographic data and the factors that may have influenced sustained ROSC in the group of OHCA paediatric patients with trauma. The non-trauma group was established as a control group. Survival analysis was used to compare differences in survival rate between trauma and non-trauma OHCA patients. Receiver operating characteristic (ROC) analysis was used to determine the significant in-hospital CPR duration related to sustained ROSC. RESULTS: Initial cardiac rhythm on arrival (P=0.005) and the duration of in-hospital CPR (P<0.001) were significant factors. Patients with PEA or VF had higher rate of sustained ROSC than those with asystole (PEA: P=0.003, VF: P=0.03). In the survival analysis, OHCA children with trauma had a lower chance of survival than non-trauma children as the interval from the scene to the ER increased (P=0.008). Based on the ROC analysis, the cut-off values of in-hospital CPR duration were 25min in OHCA paediatric patients with trauma. CONCLUSION: Several significant factors relating to sustained ROSC were determined in the OHCA paediatric patients with trauma; most importantly, we found that in-hospital CPR may have to be performed for at least 25min to enable a spontaneous circulation to return.     

Predicting survival from out-of-hospital cardiac arrest.

OBJECTIVE: To determine the effect of a return of spontaneous circulation (RO SC) on survival to hospital discharge as compared to other established predictors of survival. METHODS: A retrospective case review of all out-of-hospital primary cardiac arrests from 01 January, 1992 to 31 December 1994 was conducted. The relative values of age, race, gender, presenting cardiac rhythm, witnessed event, initiation of CPR by bystanders, response time intervals, and return of spontaneous circulation (ROSC) in an Utstein-template database were tested as predictors of survival of patients who had suffered a cardiac arrest in the out-of-hospital setting. The ROSC was defined as return of spontaneous circulation prior to and present upon arrival at the emergency department. Predictors were evaluated for statistical significance using a logistic regression analysis (p < 0.05). Odds ratios (OR) and 95% confidence intervals (CI) with positive and negative predictive values (PPV, NPV) were calculated. RESULTS: Of 832 patients with primary cardiac arrest, 153 (18.4%) had ROSC and 67 (8.1%) survived to hospital discharge. Comparing survivors to nonsurvivors, the mean values for age were 64 to 67 years, with 59.7% to 36.1% being witnessed, 35.8% to 23.9% having bystander CPR initiated, 88.1% to 48.4% having ventricular fibrillation (V-fib) and 82.1% to 64.0% having ROSC. An initial electrocardiographic rhythm of V-fib (p = 0.009; OR = 2.2; CI = 1.2-3.9), and ROSC (p < 0.0001; OR = 5.2; CI = 3.6-7.5) are statistically significant predictors of survival to hospital discharge. The PPV was 13.8% for V-fib and 35.9% for ROSC, and the NPV was 98.0% for V-fib and 98.2% for ROSC. CONCLUSION: Presenting V-fib and out-of-hospital ROSC are significant predictors of survival from cardiac arrest. Failure to obtain ROSC in the out-of-hospital setting strongly suggests consideration for terminating resuscitation efforts.     

Survey of outcome of CPR in pediatric in-hospital cardiac arrest in a medical center in Taiwan

Purpose of the studyWhile the outcomes of cardiopulmonary resuscitation (CPR) for pediatric in-hospital cardiac arrest (IHCA) are reported for many regions, none is reported for Asian countries. We report the outcomes of CPR for pediatric IHCA in a tertiary medical center in Taiwan and also identify prognostic factors associated with poor outcome.MethodsData were retrieved retrospectively from 2000 to 2003 and prospectively from 2004 to 2006 from our web-based registry system. We evaluated patients younger than 18 years of age who had IHCA and received CPR. The primary outcome was survival to hospital discharge, and the secondary outcomes were sustained return of spontaneous circulation (ROSC), and favorable neurological outcomes as assessed by pediatric cerebral performance categories (PCPC).ResultsWe identified 316 patients and the overall hospital survival was 20.9% and 16.1% had favorable neurological outcomes. Sixty-four patients ever supported with ECMO. We further analyzed 252 patients who underwent conventional CPR only and most had cardiac disease (133/252, 52.8%). The second most common preexisting condition was hematologic or oncologic disease (43/252, 17.1%). Of the 252 patients, 153 (60.7%) achieved sustained ROSC, 50 (19.8%) survived to discharge, and 39 patients (15.5%) had favorable neurological outcomes. CPR during off-work hours resulted in inferior chances of reaching sustained ROSC. Multivariate analysis showed that long CPR duration, hematology/oncology patients, and pre-arrest vasoactive drug infusion were significantly associated with decreased hospital survival (p < 0.05).ConclusionsOutcomes of CPR for pediatric patients with IHCA in Taiwan were comparable to corresponding reports in Western countries, but more hematology/oncology patients were included. Long CPR duration, hematologic or oncologic underlying diseases, and vasoactive agent infusion prior IHCA were associated with poor outcomes. The concept of palliative care should be proposed to families of terminally ill cancer patients in order to avoid unnecessary patient suffering. Also, establishing a balanced duty system in the future might increase chances of sustained ROSC.     

早期NSE联合BIS监测预测重症脑出血患者神经功能预后的价值

目的:探讨神经元特异度烯醇化酶（neuron specific enolase,NSE）和脑电双频指数（bispectral index,BIS）对重症脑出血患者神经功能预后的预测价值。方法:选取2019年1月至2020年12月期间本医院ICU收治的重症脑出血患者,早期进行血清NSE检测和BIS监测,根据脑出血后90 d患者格拉斯哥预后评分（Glasgow outcome scale,GOS）分为神经预后良好组（定义为GOS 4~5分）和神经预后不良组（定义为GOS 1~3分）,比较分析组间NSE和BIS水平,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价NSE、BIS以及两者联合预测神经预后的效能。结果:共126例重症脑出血患者入选本研究,脑出血后90 d神经功能评估为神经预后不良者有32例（25.4%）。神经预后不良组NSE水平明显高于神经预后良好组[28(13.7,50.4) ng/mL vs. 13.5 (9.6,18.5) ng/mL],而BIS水平明显低于神经预后良好组[32(25.2,45) vs. 55 (48,62.2)],差异有统计学意义（ P<0.05）。NSE及BIS预测神经不良预后的AUC分别为0.768(0.685,0.839)和0.866(0.793,0.920),截断值分别为21.7 ng/mL和47;两者联合预测神经不良预后的AUC为0.927(0.867,0.966),明显高于单一指标（ P<0.05）。 结论:早期监测NSE和BIS能有效预测重症脑出血患者的神经预后,两者联合后可进一步提高其预测效能。     

成人体外心肺复苏患者神经功能预后相关指标的预测价值研究

目的探讨成人体外心肺复苏（ECPR）患者神经功能预后相关指标的判断价值。 方法回顾性分析2018年1月至2021年4月于南京医科大学第一附属医院急诊科接受ECPR治疗的69例心脏骤停患者。根据患者出院时脑功能表现分级（CPC）评分将69例患者分为预后良好组（26例,CPC评分1 ~ 2分）和预后不良组（43例,CPC评分3 ~ 5分）。所有患者均于体外生命支持建立后24 h内接受头颅CT检查,测定其灰质/白质比例（GWR）。记录所有患者的一般资料及72 h内血清神经元特异性烯醇化酶（NSE）峰值水平。采用Spearman相关分析探讨基底节GWR与NSE水平的相关性,并采用受试者工作特征（ROC）曲线评价相关指标对ECPR患者神经功能预后的判断价值。 结果预后不良组心脏骤停患者基底节GWR [1.15（1.10,1.22）vs. 1.26 （1.22,1.28）,Z = 4.576,P < 0.001]较预后良好组显著降低,而体外膜肺氧合建立后72 h内血清NSE峰值[205.80（105.00,370.00）μg/L vs. 41.25（31.96,52.07）μg/L,Z = 5.910,P < 0.001]显著升高。Spearman相关分析结果显示,基底节GWR与NSE水平呈显著负相关（r = -0.685,P < 0.001）。ROC曲线分析结果显示,基底节GWR [曲线下面积（AUC）= 0.831,95%置信区间（CI）（0.735,0.926）,P < 0.001]及NSE 72 h内峰值[AUC = 0.926,95%CI（0.859,0.992）,P < 0.001]均对心脏骤停患者神经功能不良预后具有预测价值。基底节GWR < 1.18时,其预测神经功能不良预后的敏感度和特异度分别为62.8%和92.3%。ECMO建立后72 h内NSE峰值> 79.49 μg/L时,其预测不良预后的敏感度为83.7%,特异度为100%。 结论ECPR患者24 h内头颅CT提示GWR降低、72 h内NSE水平升高可作为预测神经功能预后不良的有效手段。     

心肺复苏后组织因子和组织因子途径抑制物的动态变化和临床意义

目的 观察院内心肺复苏后不同时间点组织因子(TF)和组织因子途径抑制物(TFPI)水平的动态变化特点并探讨其临床意义.方法 选择2005年9月至2007年9月温州医学院附属第一医院急诊科收治的年龄>16岁明确心搏停止时间的心肺复苏患者24例,依据是否达到自主循环恢复标准随机分为ROSC和末ROSC两组,分别记录小同患者心搏停止的病因和临床特点,并用ELISA方法 检测心肺复苏(CPR)后30 min,60 min,6 h,24 h,48 h血清TF和TFPI抗原浓度,10例来自健康体检的健康自愿者为对照组.计量数据用均数±标准差((-x)±s)来表示,两组计量数据的比较采用独立样本t检验,三组及以上计量数据比较采用单因素方差分析法,计数数据的比较采用旧格表精确x2榆验,以P<0.05为差异具有统计学意义.结果 与对照组比较,ROSC组患者在CPR 30 min血TF水平显著升高(P<0.01),在CPR 6 h达高峰,在CPR48 h时已下降;与对照组及ROSC组同时点比较,末ROSC组血TF水平更是显著升高(P<0.01).与对照组比较,在CPR后30 min,ROSC和未ROSC两组血清TFPI水平差异无统计学意义(P>0.05),60 min后ROSC组血清TFPI水平逐渐升高并有显著差别(P<0.01或<0.05).与对照组比较,未ROSC组和ROSC组患者在CPR 30 min时的TF/TFPI水平均显著性升高(P<0.01),且前者显著高于后者(P<0.01),在ROSC组IF/TFPI值在CPR后6 h有显著升高(P<0.01),在48 h下降.结论 血清TF和TFPI水平在院内心肺复苏的患者中明显升高,CPR后半小时的TF和TF/TFPI的水平可用于判断预后.