乳酸清除是否有助于预测心肺复苏结果和48小时死亡率?
Erdinc Senguldur1, Mehmet Cihat Demir1, Kudret Selki1
1Department of Emergency Medicine, School of Medicine, Duzce University, Duzce, Turkiye.
概括
在心肺复苏期间的乳酸清除有效预测心肺复苏结果和急诊室患者的48小时死亡率. 20分钟后乳酸清除值≤-0.15表明自发循环没有恢复.
科学领域:
- 紧急医疗 紧急医疗
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
背景情况:
- 医院内心脏骤停 (IHCA) 在急诊室是一个重大挑战.
- 预测IHCA患者的结果对于临床决策至关重要.
- 乳酸清除率 (ΔL) 越来越被认为是一种潜在的预后标志物.
研究的目的:
- 评估乳酸清除 (ΔL) 对心肺复苏 (CPR) 结果和48小时死亡率的预测值.
- 在心肺复苏过程中,在目击心脏骤停的患者中,在特定时间点评估 ΔL.
- 为了确定 ΔL 在指导 CPR 延续或终止决策中的实用性.
主要方法:
- 在2023年7月1日至12月31日的紧急医疗部门进行了一项观察性研究.
- 包括18岁以上在医院内心脏骤停的患者,不包括创伤,严重出血或恶性瘤.
- 使用接收器操作特征 (ROC) 和乳酸清除 (ΔL) 的风险分析进行前性数据收集和分析.
主要成果:
- 10,20和10-20分钟的乳酸清除率 (ΔL) 对没有ROSC (自发循环恢复) 和48小时死亡率都有很高的预测能力.
- 对于DL0-10,DL0-20和DL10-20的AUC值在没有ROSC和48小时死亡率预测方面始终很高.
- 在 ΔL0-20 值 ≤-0.15 的患者中没有观察到 ROSC,而低的 ΔL 将不良结果的风险增加了十倍.
结论:
- 在心肺复苏期间的乳酸清除率 (ΔL) 是预测心肺复苏成功和患者存活率的宝贵工具.
- 在心肺复苏20分钟后评估的DL0-20值是确定是否继续或停止复苏工作的重要参数.
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