Objective To explore the relationship between the dynamic changes of pH and lactic acid and prognosis in patients with cardiopulmonary resuscitation(CPR)treated with mild hypothermia.Methods A total of 103 patients who were successfully treated with cardiopulmonary resuscitation after cardiac arrest in our hospital from May 2018 to May 2023 were selected as the study objects.According to the different prognosis,the patients were divided into a good prognosis group(38 cases)and a poor prognosis group(65 cases).The dynamic changes of pH and lactic acid levels in mild hypothermia cardiopulmonary resuscitation patients were analyzed and compared by repeated measurement variance method.The Joint model was used to analyze the relationship between pH value and lactic acid level and the prognosis of cardiopulmonary resuscitation patients treated with mild hypothermia.The longitudinal fluctuation multilevel submodel(LME model)and Cox survival submodel were constructed,and the two were combined by association coefficient.At the same time,the impact of baseline and longitudinal data over time on survival risk function was analyzed.Multi-factor Logistics regression was used to analyze the factors affecting the prognosis of patients with cardiopulmonary resuscitation,and the relationship between pH value and lactic acid and the prognosis of patients with cardiopulmonary resuscitation treated with mild hypothermia was analyzed by Logistic regression,and a prediction model was established.Receiver operating characteristic curve(ROC)and area under ROC curve(AUC)were used to estimate the discriminant tangent points of the model.Results(1)Coma degree,APACHE Ⅱ score,mechanical ventilation time,recovery time of spontaneous circulation,time of admission to emergency critical care unit(EICU),left ventricular ejection fraction(LVEF),pH value,lactic acid level,12 hours lactic acid clearance rate,24 hours lactic acid clearance and serum creatinine were significantly different(P<0.05).(2)The results of repeated measurement ANOVA showed that the time effect,intergroup effect and interaction effect of pH and lactic acid levels in the 2 groups were statistically significant(P<0.001).The results of one-way repeated measurement ANOVA showed that:compared with before treatment,pH values in both groups showed a significant upward trend(P<0.001).The levels of lactic acid decreased significantly(P<0.001).The results of multivariate analysis of variance showed that the pH values of 12 hours,24 hours and 72 hours after treatment in poor prognosis group were lower than those in the good prognosis group(P<0.001).The levels of lactic acid at 12 hours,24 hours and 72 hours after treatment in poor prognosis group ere higher than those in good prognosis group(P<0.001).(3)The results of Joint model analysis showed that the risk of poor prognosis increased by 5%for every 0.1 decrease in pH value(P<0.01).For each 1 mmol/L increase in lactate level,the risk of poor prognosis increased by 4%(P<0.01).(4)Multivariate Logistic regression analysis showed that recovery time of spontaneous circulation,severe coma,pH value and lactic acid level were independent risk factors for poor prognosis of patients treated with mild hypothermia cardiopulmonary resuscitation(P<0.01).(5)According to the above influencing factors,the prediction model for the prognosis of patients with cardiopulmonary resuscitation treated with mild hypothermia was well distinguished and accurate.The total coincidence rate of theoretical discrimination and actual data is 82.93%,and the misjudgment rate is 17.07%.Conclusion The dynamic changes of pH and lactic acid are important factors affecting the prognosis of patients with mild hypothermia cardiopulmonary resuscitation.High lactic acid level and low pH value are high risk factors for poor prognosis in patients with cardiopulmonary resuscitation.
维普
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