呼气末二氧化碳分压监测用于心肺复苏及预后评估研究

目的 探讨呼气末二氧化碳分压（PETCO2）监测在急诊科心肺复苏质量及预后评估中的价值，为临床终止CPR提供参考。方法 将急诊科收治的62例心脏骤停患者，根据复苏结果分为自主循环恢复组（ROSC组）32例和非自主循环恢复组（非ROSC组）30例，比较两组患者的一般资料及不同时间节点PETCO2。根据复苏后7 d、28 d生存情况将自主循环恢复者分为生存组和死亡组，比较两组不同时间节点PETCO2。绘制ROC曲线，根据约登指数得出预测ROSC、7 d及28 d生存率的最佳截断值。结果 ROSC组和非ROSC组发病地点、CPR持续时间、肾上腺素及5%碳酸氢钠累计使用剂量差异有统计学意义（均P<0.05）；两组在心肺复苏10 min及之后各个时间节点的PETCO2值差异有统计学意义（均P<0.05）；复苏30 min以内，20 min时PETCO2预测ROSC的曲线下面积最大（AUC=0.982， 95%CI：0.955~1.000），PETCO2最佳截断值为16.5 mmHg，敏感度和特异度分别为93.8%和96.7%，约登指数0.904。ROSC后7 d生存组与死亡组在ROSC时、心肺复苏15 min及之后各时间节点的PETCO2差异有统计学意义（均P<0.05）；心肺复苏20 min时PETCO2值预测ROSC后7 d生存率的曲线下面积最大（AUC=0.882, 95%CI：0.739~1.000），最佳截断值为30 mmHg，敏感度和特异度均为83.3%，约登指数0.667；ROSC后28 d生存组与死亡组在ROSC时、心肺复苏10 min及之后的各时间节点的PETCO2差异有统计学意义（均P<0.05），心肺复苏50 min时PETCO2值预测ROSC后28 d生存的曲线下面积最大（AUC=0.893，95%CI：0.764~1.000），最佳截断值为27.5 mmHg，其敏感度和特异度分别为100%和73.3%，约登指数0.733。结论 呼气末PETCO2能够指导急诊护理人员评价心脏骤停患者心肺复苏质量，并可作为预测患者临床结局的重要指标。

Application of end-tidal carbon dioxide partial pressure monitoring in cardiopulmonary resuscitation and prognosis assessment

Objective To explore the application value of End-tidal Carbon Dioxide Partial Pressure (PETCO2) monitoring in the quality and prognosis assessment of Cardiopulmonary Resuscitation (CPR) in emergency department, so as to provide a reference for clinical termination of CPR. Method A total of 62 patients suffered from cardiac arrest and admitted to the emergency department were divided into a return of spontaneous circulation group (ROSC group) of 32 cases and a non return of spontaneous circulation group (non-ROSC group) of 30 cases according to their resuscitation results, and their general information and PETCO2 values at different time points were compared between the two groups. Then the patients in the ROSC group were divided into a survival group and a death group according to their survival conditions at 7 days and 28 days after resuscitation, and the PETCO2 values at different time points were compared betweenthe two groups. Finally, the ROC curve was plotted and the optimal cutoff values predicting ROSC, 7 days and 28 days survival rates were obtained according to the Youden index. Results There were statistically significant differences in the place of onset, duration of CPR, cumulative doses of epinephrine and 5% sodium bicarbonate between the ROSC group and the non-ROSC group (all P<0.05), and there were statistically significant differences in the PETCO2 values between the two groups at various time points after undergoing CPR for 10 min or longer (all P<0.05); when undergoing CPR within 30 min, the area under the ROC curve of ROSC predicted by PETCO2 value at 20 min of CPR was the largest (AUC=0.982, 95% CI:0.955-1.000), the optimal cutoff value was 16.5 mmHg, the sensitivity and specificity were 93.8% and 96.7% respectively, and the Youden index was 0.904. There were statistically significant differences in the PETCO2 values 〖HJ*3〗between the 7 days survival group and the death group after ROSC at the point of ROSC,15 min or longer of CPR (all P<0.05); at 20 min of CPR, PETCO2 predicted the largest area under the curve of 7 days survival rate after ROSC（AUC=0.882, 95%CI：0.739-1.000）, the optimal cutoff value was 30 mmHg, the sensitivity and specificity were both 83.3%, and the Youden index was 0.667.There were statistically significant differences in the PETCO2 values between the 28 days survival group and the death group after ROSC at the point of ROSC,10 min or longer of CPR(all P<0.05); at 50 min of CPR, PETCO2 predicted the largest area under the curve of 28 days survival rate after ROSC（AUC=0.893, 95%CI：0.764-1.000),the optimal cutoff value was 27.5 mmHg, the sensitivity and specificity were 100% and 73.3% respectively, and the Youden index was 0.733. Conclusion PETCO2 monitoring can guide emergency nurses to evaluate the quality of CPR in patients suffered from cardiac arrest, and can be used as an important indicator to predict the clinical outcomes of patients.