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。

Study on the predictive value of neurological prognosis-related indicators in survivors of adult extracorporeal cardiopulmonary resuscitation

ObjectiveTo evaluate the prognostic value of neurological outcome predictors in survivors of adult extracorporeal cardiopulmonary resuscitation (ECPR). MethodsA total of 69 cardiac arrest patients who were treated with ECPR in Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2018 to April 2021 were enrolled in this single-center retrospective study. In accordance with the cerebral performance category (CPC) scale at discharge, the patients were divided into a good outcome group (CPC 1-2, n = 26) and a poor outcome group (CPC 3-5, n = 43). All patients underwent CT scans within 24 h after establishment of extracorporeal life support and the gray-white matter ratio (GWR) was calculated according to previous studies. The peak levels of serum neuron-specific enolase (NSE) within 72 h as well as clinical information were recorded. Spearman's correlation analysis was performed to evaluate the relationship between basal ganglia GWR and NSE. Receiver operating characteristic (ROC) curve analysis was drawn to determine the prognostic value of neurological outcome predictors in patients who were treated with ECPR. ResultsThe basal ganglia GWR 1.15 (1.10, 1.22) vs. 1.26 (1.22, 1.28), Z = 4.576, P < 0.001] was significantly lower in the poor outcome group than in the good one, while the peak level of NSE within 72 h after extracorporeal membrane oxygenation establishment 205.80 (105.00, 370.00) μg/L vs. 41.25 (31.96, 52.07) μg/L, Z = 5.910, P < 0.001] was significantly higher in the poor outcome group. The results of Spearman's correlation analysis revealed that basal ganglia GWR was negatively correlated with the NSE level (r = -0.685, P < 0.001). The results of ROC curve analysis showed that basal ganglia GWR area under the curve (AUC) = 0.831, 95% confidence interval (CI) (0.735, 0.926), P < 0.001] and the peak level of NSE within 72 h AUC = 0.926, 95%CI(0.859, 0.992), P < 0.001] both had predictive value for poor neurological prognosis in CA patients. The basal ganglia GWR < 1.18 predicted a poor outcome with a sensitivity and specificity of 62.8% and 92.3%, respectively. The peak level of NSE within 72 h > 79.49 μg/L predicted a poor outcome with 83.7% sensitivity and 100% specificity. ConclusionThe decreased GWR from brain CT within 24 h after establishment of extracorporeal life support and the elevated level of NSE can be promising tools to assess a poor neurological outcome in survivors of adult ECPR.