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心肺复苏后昏迷患者神经功能预后评估的研究进展
周法庭
马渝
赵金川
熊丽
何杨俊
沈一鸣
罗杰
朱晓丹
艾山木
作者及单位信息
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DOI： 10.3760/cma.j.issn.1671-0282.2025.03.031
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摘要

心脏骤停（cardiac arrest, CA）是指各种原因导致心脏泵血功能突然终止，大动脉搏动和心音消失，心脏和大脑等重要器官严重缺血缺氧，最终引起患者死亡。据报道欧美成年院内心脏骤停（in-hospital cardiac arrest, IHCA）患者发病率为0.3%~0.9%，经心肺复苏后35%~44%的患者可恢复自主循环（return of spontaneous circulation, ROSC），出院生存率为7%~26% [1,2,3,4,5]。与欧美国家比较，我国IHCA发病率高而出院生存率低，IHCA发生率为1.75%，出院存活率仅为9.7% [6]。此外，我国人口基数大，人口老龄化日益加重，CA形势严峻，已成为严重的公共卫生问题 [7]。

引用本文

周法庭,马渝,赵金川,等. 心肺复苏后昏迷患者神经功能预后评估的研究进展[J]. 中华急诊医学杂志,2025,34(03)：447-454.

DOI:10.3760/cma.j.issn.1671-0282.2025.03.031

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心脏骤停（cardiac arrest, CA）是指各种原因导致心脏泵血功能突然终止，大动脉搏动和心音消失，心脏和大脑等重要器官严重缺血缺氧，最终引起患者死亡。据报道欧美成年院内心脏骤停（in-hospital cardiac arrest, IHCA）患者发病率为0.3%~0.9%，经心肺复苏后35%~44%的患者可恢复自主循环（return of spontaneous circulation, ROSC），出院生存率为7%~26% [ 1 , 2 , 3 , 4 , 5 ]。与欧美国家比较，我国IHCA发病率高而出院生存率低，IHCA发生率为1.75%，出院存活率仅为9.7% [ 6 ]。此外，我国人口基数大，人口老龄化日益加重，CA形势严峻，已成为严重的公共卫生问题 [ 7 ]。
高质量心肺复苏(cardiopulmonary resuscitation, CPR)是挽救CA患者最常用的办法，然而CA患者神经功能预后与患者基础疾病、病因、年龄、性别、有无目击者、复苏持续时间和是否为可电击心律等诸多因素相关 [ 8 , 9 , 10 , 11 ]，复苏后患者的神经功能存在显著差异，部分患者出院后长期遗留中度到重度神经功能障碍 [ 12 ]。持续动态评估复苏后昏迷患者的神经功能，指导临床决策，防止对苏醒无望患者的过度治疗。国内外指南和共识推荐采用神经系统查体、神经影像学、电生理检查和血清标志物等方法评估复苏后患者的神经功能 [ 1 , 13 ]。然而目前缺乏规范化和标准化流程，各研究间报道的敏感度并不完全相同，指南也未详尽描述各个评估方法的影响因素和注意事项。本综述基于现有的研究报道，结合CA后脑组织病理生理改变，总结各项神经功能预后评估方法的特征、优势和不足，为临床医生科学评估心肺复苏后患者的神经功能提供参考。
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艾山木，Email: mocdef.3ab6191umnahsia
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