脑电双频指数及凝血功能对心肺复苏自主循环恢复后老年患者神经功能预后的评估

明确BIS及凝血功能监测对心肺复苏（cardiopulmonary resuscitation, CPR）自主循环恢复（return of spontaneous circulation, ROSC）后实施目标温度管理（target temperature management, TTM）的老年患者神经系统预后的评估价值。 方法 选取28例年龄≥60岁、CPR后ROSC且行TTM的患者，根据ROSC后3个月患者的格拉斯哥-匹兹堡脑功能分级（cerebral performance categories, CPC）评分，将其分为A组和B组：A组为预后良好组（CPC 1~3分），12例；B组为预后不良组（CPC 4~5分），16例。分析两组患者ROSC后24 h（T1）、48 h（T2）、72 h（T3）的BIS、凝血酶原时间（prothrombin time, PT）、活化部分凝血酶原时间（activated partial thromboplastin time, APTT）、凝血酶时间（thrombin time, TT）、纤维蛋白原（fibrinogen, Fib）、D-二聚体（D-dimer, D-D）。 结果 与A组比较，T1时间点B组患者BIS值差异无统计学意义（P〉0.05），PT、APTT、TT值均显著增加，Fib、D-D值显著降低，差异有统计学意义（P〈0.05）；与A组比较，T2、T3时间点B组患者PT、APTT、TT、D-D值均显著增加，BIS、Fib值显著降低，差异均有统计学意义（P〈0.05）；A组T2时间点PT、APTT、TT、Fib指标水平变化达峰值，T3时间点PT、APTT、TT、Fib指标明显改善，差异有统计学意义（P〈0.05）；与T1时间点比较，B组T2时间点PT、APTT、TT、Fib、D-D差异有统计学意义，T3时间点较T2时间点差异无统计学意义（P〈0.05）；两组BIS值在ROSC后呈逐渐升高趋势。 结论 BIS、凝血功能对CPR后ROSC并实施TTM老年患者的神经系统功能预后具有评估参考价值。

Neurological prognosis of elderly patients recovered from cardiopulmonary resuscitation

Objective To evaluate neurological prognosis in elderly patients receiving cardiopulmonary resuscitation (CPR) with BIS and coagulation monitoring. Methods Twenty-eight elderly patients with return of spontaneous circulation (ROSC) after CPR were treated with targeted temperature management (TTM). According to cerebral performance categories (CPC), 3 months after ROSC, the patients were divided into two groups: group A (CPC 1-3, recovered well) and group B (CPC 4-5, vegetative state or death). Dynamic changes in BIS, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib), and D-Dimer (D-D) were determined 24 h(T1), 48 h(T2), and 72 h(T3) after ROSC. Results At T1, BIS was similar in group A (n=12) and group B (n=16) (P>0.05), but PT, APTT, TT were significantly higher in group B (P<0.05), Fib and D-D were significantly lower in group B (P<0.05). At T2 and T3, PT, APTT, TT, and D-D were higher, but Fib and BIS were lower in group B (P<0.05). BIS values were significant higher in group B at T2 and T3. In group A, at T2, PT, APTT, TT, and Fib were higher than T1 and T3. There was a significant improvement at T3. In group B, there were significant differences in PT, APTT, TT and Fib between T1 and T2, but at T3, there was no significant improvement. The BIS values gradually increasing after ROSC. Conclusions Early BIS and coagulation function can be used to evaluate the neurological prognosis of elderly patients after CPR, receiving TTM.