入院时氧化应激指数与心脏骤停患者心肺复苏失败的关系研究
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摘要
目的分析入院时氧化应激指数(OSI)与心脏骤停患者心肺复苏(CPR)失败的关系。方法选取2017年2月—2018年2月在陆军总医院急诊科就诊的心脏骤停患者90例,根据CPR结果分为成功组46例和失败组44例;另选取同期体检健康者40例作为对照组。比较失败组和成功组患者临床特征及3组受试者入院时OSI;绘制ROC曲线以评价入院时OSI对心脏骤停患者CPR失败的预测价值,入院时OSI与心脏骤停患者CPR失败的关系分析采用多因素Logistic回归分析。结果 (1)成功组和失败组患者年龄≥60岁者所占比例、男性比例、高血压发生率、糖尿病发生率、冠心病发生率、慢性阻塞性肺疾病发生率、心电图电机械分离及无脉性室速检出率、pH值、血氧饱和度、血红蛋白、血小板计数及肌钙蛋白比较,差异无统计学意义(P>0.05);失败组患者接受院外复苏者所占比例、心电图心脏停搏检出率、缺血修饰蛋白、血钠及血钾高于成功组,心脏骤停持续时间长于成功组(P<0.05)。(2)成功组和失败组患者入院时OSI高于对照组,失败组患者入院时OSI高于成功组(P<0.05)。(3)ROC曲线显示,入院时OSI预测心脏骤停患者CPR失败的曲线下面积为0.79[95%CI(0.68,0.91)],最佳截断值为6.02,灵敏度为94.1%,特异度为64.0%。(4)多因素Logistic回归分析结果显示,入院时OSI是心脏骤停患者CPR失败的独立影响因素[OR=4.563,95%CI(1.064,19.576),P<0.05]。结论心脏骤停患者处于氧化应激状态,且入院时OSI>6.02者CPR失败风险较高,因此对入院时OSI较高的心脏骤停患者行抗氧化应激治疗可能提高其CPR成功率。
Objective To analyze the relationship between oxidative stress index(OSI)at admission and cardiopulmonary resuscitation failure in patients with sudden cardiac arrest. Methods From February 2017 to February 2018,a total of 90 patients with sudden cardiac arrest were selected in the Department of Emergency,General Hospital of Land Force of Chinese People's Liberation Army,and they were divided into A group(with successful cardiopulmonary resuscitation,n=46)and B group(with unsuccessful cardiopulmonary resuscitation,n=44)according to the cardiopulmonary resuscitation outcome;meanwhile a total of 40 healthy volunteers admitted to this hospital for physical examination were selected as control group. Clinical features were compared between A group and B group,and OSI at admission was compared in control group,A group and B group;ROC curve was drawn to evaluate the predictive value of OSI at admission on cardiopulmonary resuscitation failure in patients with sudden cardiac arrest,and multivariate Logistic regression analysis was used to analyze the relationship between OSI at admission and cardiopulmonary resuscitation failure. Results(1)No statistically significant differences of proportion of patients equal or over 60 years old,male proportion,incidence of hypertension,diabetes,coronary heart disease or chronic obstructive pulmonary disease,detection rate of electromechanical dissociation or pulseless ventricular tachycardia of ECG,pH value,oxyhemoglobin saturation,hemoglobin,blood platelet count or troponin was found between A group and B group(P>0.05);proportion of patients underwent cardiopulmonary resuscitation outside the hospital,detection rate of cardiac arrest of ECG,ischemia modified protein,serum sodium and serum kalium in B group were statistically significantly higher than those in A group,and duration of sudden cardiac arrest in B group was statistically significantly longer than that in A group(P<0.05).(2)OSI at admission in A group and B group was statistically significantly higher than that in control group,respectively,meanwhile OSI at admission in B group was statistically significantly higher than that in A group(P<0.05).(3)ROC curve showed that,AUC of OSI at admission in predicting cardiopulmonary resuscitation failure was 0.79[95%CI(0.68,0.91)]in patients with sudden cardiac arrest,the optimum truncation value was 6.02,the sensitivity was 94.1%,the specificity was 64.0%.(4)Multivariate Logistic regression analysis results showed that,OSI at admission was one of independent influencing factors of cardiopulmonary resuscitation failure in patients with sudden cardiac arrest[OR=4.563,95%CI(1.064,19.576),P<0.05]. Conclusion Oxidative stress exists in patients with sudden cardiac arrest,patients with OSI over 6.02 at admission have relatively high risk of cardiopulmonary resuscitation failure,thus anti-oxidative stress treatment may improve the success rate of cardiopulmonary resuscitation.
Objective To analyze the relationship between oxidative stress index(OSI)at admission and cardiopulmonary resuscitation failure in patients with sudden cardiac arrest. Methods From February 2017 to February 2018,a total of 90 patients with sudden cardiac arrest were selected in the Department of Emergency,General Hospital of Land Force of Chinese People's Liberation Army,and they were divided into A group(with successful cardiopulmonary resuscitation,n=46)and B group(with unsuccessful cardiopulmonary resuscitation,n=44)according to the cardiopulmonary resuscitation outcome;meanwhile a total of 40 healthy volunteers admitted to this hospital for physical examination were selected as control group. Clinical features were compared between A group and B group,and OSI at admission was compared in control group,A group and B group;ROC curve was drawn to evaluate the predictive value of OSI at admission on cardiopulmonary resuscitation failure in patients with sudden cardiac arrest,and multivariate Logistic regression analysis was used to analyze the relationship between OSI at admission and cardiopulmonary resuscitation failure. Results(1)No statistically significant differences of proportion of patients equal or over 60 years old,male proportion,incidence of hypertension,diabetes,coronary heart disease or chronic obstructive pulmonary disease,detection rate of electromechanical dissociation or pulseless ventricular tachycardia of ECG,pH value,oxyhemoglobin saturation,hemoglobin,blood platelet count or troponin was found between A group and B group(P>0.05);proportion of patients underwent cardiopulmonary resuscitation outside the hospital,detection rate of cardiac arrest of ECG,ischemia modified protein,serum sodium and serum kalium in B group were statistically significantly higher than those in A group,and duration of sudden cardiac arrest in B group was statistically significantly longer than that in A group(P<0.05).(2)OSI at admission in A group and B group was statistically significantly higher than that in control group,respectively,meanwhile OSI at admission in B group was statistically significantly higher than that in A group(P<0.05).(3)ROC curve showed that,AUC of OSI at admission in predicting cardiopulmonary resuscitation failure was 0.79[95%CI(0.68,0.91)]in patients with sudden cardiac arrest,the optimum truncation value was 6.02,the sensitivity was 94.1%,the specificity was 64.0%.(4)Multivariate Logistic regression analysis results showed that,OSI at admission was one of independent influencing factors of cardiopulmonary resuscitation failure in patients with sudden cardiac arrest[OR=4.563,95%CI(1.064,19.576),P<0.05]. Conclusion Oxidative stress exists in patients with sudden cardiac arrest,patients with OSI over 6.02 at admission have relatively high risk of cardiopulmonary resuscitation failure,thus anti-oxidative stress treatment may improve the success rate of cardiopulmonary resuscitation.
引文
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[13]KLENIEWSKAP,PAWLICZAKR.Theparticipationof oxidative stress in the pathogenesis of bronchial asthma[J].Biomed Pharmacother,2017,94:100-108.DOI:10.1016/j.biopha.2017.07.066.
[14]RAY P D,HUANG B W,TSUJI Y.Reactive oxygen species(ROS)homeostasis and redox regulation in cellular signaling[J].Cell Signal,2012,24(5):981-990.DOI:10.1016/j.cellsig.2012.01.008.
[15]NIEMANN B,ROHRBACH S,MILLER M R,et al.Oxidative Stress and Cardiovascular Risk:Obesity,Diabetes,Smoking,and Pollution:Part 3 of a 3-Part Series[J].J Am Coll Cardiol,2017,70(2):230-251.DOI:10.1016/j.jacc.2017.05.043.
[16]YUCEL H,TURKDOGAN K A,ZORLU A,et al.Association between oxidative stress index and post-CPR early mortality in cardiac arrest patients:A prospective observational study[J].Anatol J Cardiol,2015,15(9):737-743.doi:10.5152/akd.2014.5719.
[17]TUREDI S,GUNDUZ A,MENTESE A,et al.Investigation of the possibility of using ischemia-modified albumin as a novel and early prognostic marker in cardiac arrest patients after cardiopulmonary resuscitation[J].Resuscitation,2009,80(9):994-999.DOI:10.1016/j.resuscitation.2009.06.007.
[2]葛志文,涂久生,张永耀,等.不同吸氧浓度心肺复苏术对心脏骤停患者预后的影响研究[J].实用心脑肺血管病杂志,2016,24(2):121-122.
[3]LU J,LIU L,ZHU J,et al.Factors Influencing the Quality of Standardized Treatment for Patients with Post-Cardiac Arrest Syndrome[J].Korean Circ J,2017,47(4):455-461.DOI:10.4070/kcj.2016.0437.
[4]JUNG J,ZAUROVA M.Optimizing survival outcomes for adult patients with nontraumatic cardiac arrest[J].Emerg Med Pract,2016,18(10):1-24.
[5]WANG G,ZHANG Q,YUAN W,et al.Enalapril protects against myocardial ischemia/reperfusion injury in a swine model of cardiac arrest and resuscitation[J].Int J Mol Med,2016,38(5):1463-1473.DOI:10.3892/ijmm.2016.2737.
[6]秦历杰.《2015年美国心脏协会心肺复苏及心血管急救指南更新》解读[J].中华实用诊断与治疗杂志,2017,31(10):937-939.
[7]WEI Y,SHEN X N,MAI J Y,et al.The effects of lycopene on reactive oxygen species and anoxic damage in ischemia reperfusion injury in rats[J].Zhonghua Yu Fang Yi Xue Za Zhi,2010,44(1):34-38.
[8]赵娟,李淑霞.心源性猝死患者发病特点及心肺复苏成功的影响因素分析[J].实用心脑肺血管病杂志,2017,25(4):102-105.DOI:10.3969/j.issn.1008-5971.2017.04.025.
[9]刘致强,米伟,周雪,等.机械胸外心脏按压救治心脏骤停患者的有效性及其对心脑功能损伤的影响[J].疑难病杂志,2017,16(9):919-921,926.DOI:10.3969/j.issn.1671-6450.2017.09.014.
[10]KIM J,KIM J,KOOK H,et al.PICOT alleviates myocardial ischemia-reperfusion injury by reducing intracellular levels of reactive oxygen species[J].Biochem Biophys Res Commun,2017,485(4):807-813.DOI:10.1016/j.bbrc.2017.02.136.
[11]PAHWA R,ADAMS-HUET B,JIALAL I.The effect of increasing body mass index on cardio-metabolic risk and biomarkers of oxidative stress and inflammation in nascent metabolic syndrome[J].J Diabetes Complications,2017,31(5):810-813.DOI:10.1016/j.jdiacomp.2017.02.010.
[12]STUBD,BERNARDS,DUFFYSJ,etal.Postcardiac arrestsyndrome:areviewoftherapeuticstrategies[J].Circulation,2011,123(13):1428-1435.DOI:10.1161/CIRCULATIONAHA.110.988725.
[13]KLENIEWSKAP,PAWLICZAKR.Theparticipationof oxidative stress in the pathogenesis of bronchial asthma[J].Biomed Pharmacother,2017,94:100-108.DOI:10.1016/j.biopha.2017.07.066.
[14]RAY P D,HUANG B W,TSUJI Y.Reactive oxygen species(ROS)homeostasis and redox regulation in cellular signaling[J].Cell Signal,2012,24(5):981-990.DOI:10.1016/j.cellsig.2012.01.008.
[15]NIEMANN B,ROHRBACH S,MILLER M R,et al.Oxidative Stress and Cardiovascular Risk:Obesity,Diabetes,Smoking,and Pollution:Part 3 of a 3-Part Series[J].J Am Coll Cardiol,2017,70(2):230-251.DOI:10.1016/j.jacc.2017.05.043.
[16]YUCEL H,TURKDOGAN K A,ZORLU A,et al.Association between oxidative stress index and post-CPR early mortality in cardiac arrest patients:A prospective observational study[J].Anatol J Cardiol,2015,15(9):737-743.doi:10.5152/akd.2014.5719.
[17]TUREDI S,GUNDUZ A,MENTESE A,et al.Investigation of the possibility of using ischemia-modified albumin as a novel and early prognostic marker in cardiac arrest patients after cardiopulmonary resuscitation[J].Resuscitation,2009,80(9):994-999.DOI:10.1016/j.resuscitation.2009.06.007.