目的:影响神经系统预后的因素和神经元特异性烯醇化酶(NSE)的有效性,S-100B,胶质纤维酸性蛋白(GFAP),在心肺复苏(CPR)后存活至少24小时的患者中,评估降钙素原(PCT)对神经系统预后的预测作用.
方法:这项前瞻性临床研究包括30例成功复苏的心脏骤停患者。最初的心脏骤停节律,CPR的持续时间,自发循环时间的恢复,给药剂量的肾上腺素,碱过量,血糖,并记录血流动力学参数。将格拉斯哥预后量表(GOS)评分为1-3分的患者定义为I组,将GOS评分为4-5分的患者定义为II组。血清NSE,GFAP,S-100B,在心肺复苏后不久(0小时)和复苏后12小时和24小时比较两组的PCT水平。
结果:在心肺复苏后即刻,II组血清S-100B显著升高(P=0.009)。存活出院的患者在CPR后第0、12和24小时的血清S-100B和NSE显着降低。12、24小时血清PCT和0、12、24小时CPR后血清S-100B敏感性达94.7%。血清NSE,GFAP,S-100B,PCT特异性低于50%。
结论:在预测神经系统结局时,CPR后即刻血清S-100B敏感性高,特异性低。
OBJECTIVE: Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR).
METHODS: Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical
study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded. Patients with Glasgow Outcome Scale (GOS) scores of 1-3 were defined as Group I and patients with GOS scores of 4-5 were defined as Group II. Serum NSE, GFAP, S-100B, and PCT levels were compared between the two groups shortly after CPR (hour 0) and at hours 12 and 24 of the postresuscitation period.
RESULTS: Serum S-100B was significantly higher (P = 0.009) in Group II immediately after CPR. Serum S-100B and NSE after CPR at hours 0, 12, and 24 were significantly lower in patients who survived to hospital discharge. Serum PCT at hours 12 and 24 and serum S-100B after CPR at 0, 12, and 24 h reached 94.7% sensitivity. Serum NSE, GFAP, S-100B, and PCT specificities were lower than 50%.
CONCLUSIONS: In predicting neurological outcomes, serum S-100B has high sensitivity and low specificity immediately after CPR.