心肺复苏中血氧分压和血乳酸水平的变化及其意义

目的 探讨心肺复苏(CPR)患者血氧分压和血乳酸水平与预后的关系.方法 36例心脏骤停后CPR患者依据复苏效果分为三组:A组(21例):心肺复苏30 min无效死亡；B组(10例):复苏成功,自主循环建立≥2 h,但最终死亡；C组(5例):复苏成功,存活出院.选择20例同期健康体检者作为对照组.于CPR0、1、3、6、12 h留取动脉血分别测定血氧分压与乳酸水平,比较各组患者该指标的动态变化.结果 在CPR即刻,A、B、C三组血氧分压明显降低分别为(26.2±1.4)、(34.8±1.2)、(43.8±1.2)mm Hg],血乳酸明显升高分别为(12.4±3.1)、(10.6±2.6)、(6.9±1.6) mmol/L],与对照组分别为(73.8±1.2)mm Hg、(2.8±0.6) mmol/L]比较差异均有统计学意义(均P＜0.01)；B组于CPR 3、6h无明显变化并持续至12 h；C组于CPR 3、6h血氧分压开始升高,血乳酸水平开始下降,12 h血氧分压升高明显,血乳酸降至较低水平；C组与B组比较差异有统计学意义(P＜0.05).结论 动脉血氧分压与血乳酸水平可作为CPR患者预后的指标.动脉血氧分压持续升高表明预后良好,乳酸水平持续升高表明预后不良.

The changes of arterial partial pressure of oxygen and blood lactate level in patients with cardiopulmonary resuscitation and its clinical significance

Objective To explore the relation between the level of oxygen pressure and lactate in arterial blood and prognosis of cardiopulmonary resuscitation （CPR）. Methods 36 patients with sudden cardiac arrest received CPR were selected. Patients were divided into 3 groups. The 21 patients who 30 minutes of CPR didn＇t regain heart beats were group A, those 10 who kept blood circulation for over 2 hours but finally died were group B, and the remaining 5 who survived were group C. Control group was made up of 20 people with no disease. In CPR immediately （Oh）, l h,3h,6h, 12h were measured in blood specimens from arterial partial pressure of oxygen and lactate levels were compared among groups of patients dynamic changes of the index. Results The 3 groups A, B, C significantly reduced blood oxygen pressure, blood lactate increased significantly the CPR in the early, and compared with the control group there was significant difference （ P 〈 0.01 ）. The group B CPR 3h, 6h, and continue until no significant changes in 12h;The group C CPR 3h,6h began to increase blood oxygen pressure and blood lactate levels begin to decline, blood oxygen pressure increased significantly,lower blood lactate to a lower level after 12h. Taken with marked changes in B group, the difference was significant （ P 〈 0.05 ）. Conclusion Arterial partial pressure of oxygen and blood lactate levels could be used as indicators of prognosis of patients with CPR. Sustained increase in arterial oxygen partial pressure showed a good prognosis,lactate levels continued to rise that a poor prognosis.