Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study
Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study
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DOI：
10.1007/s00134-002-1573-2
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发表时间：
2003-02-01
影响因子：
38.9
通讯作者：
Zandstra, DF
中科院分区：
文献类型：
--
作者：
Meynaar, IA;Oudemans-van Straaten, HM;Zandstra, DF
目的：本研究的目的是探讨是否可以使用系列血清神经元特异性烯醇化酶（NSE）来预测心肺复苏（CPR）后仍然昏迷的患者的神经预后。设计：观察性队列研究。临床医生对NSE结果不知情。设置：18床普通ICU。患者：CPR后进入ICU的昏迷患者。干预措施：在入院时和每天连续5天测定血清NSE。测量和结果：患者接受全面强化治疗，直至复苏或直至心肺复苏后48 h以上无皮层体感诱发电位反应证明为不可逆昏迷。在纳入的110例患者中（ICU入院时平均GCS 3，范围3-9），34例恢复意识，其中5例在医院死亡。76名患者没有恢复意识，其中72人在医院死亡。心肺复苏后24小时和48小时，未恢复意识的患者血清NSE显著高于恢复意识的患者（24小时：中位NSE 29.9 mug/l，范围1.8-250 vs 9.9 mug/l，范围4.5-21.5，P 25.0 mug/l）。在GCS和体感诱发电位中加入NSE可将不良神经功能结局的预测性从64%提高到76%。结论：CPR后24 h和48 h昏迷患者血清NSE水平升高预示神经功能预后不良。在GCS和体感诱发电位中加入NSE可增加神经功能预后的预测性。
Objective: The aim of this study was to investigate whether serial serum neuron-specific enolase (NSE) can be used to predict neurological prognosis in patients remaining comatose after cardiopulmonary resuscitation (CPR). Design: Observational cohort study. Clinicians were blinded to NSE results. Setting: Eighteen-bed general ICU. Patients: Comatose patients admitted to the ICU after CPR. Interventions: Serum NSE was measured at admission and daily for 5 days. Measurements and results: Patients received full intensive treatment until recovery or until absence of cortical response to somatosensory evoked potentials more than 48 h after CPR proved irreversible coma. Of the 110 patients included (mean GCS at ICU admission 3, range 3-9), 34 regained consciousness, five of whom died in hospital. Seventy-six patients did not regain consciousness, 72 of whom died in hospital. Serum NSE at 24 h and at 48 h after CPR was significantly higher in patients who did not regain consciousness than in patients who regained consciousness (at 24 h: median NSE 29.9 mug/l, range 1.8-250 vs 9.9 mug/l, range 4.5-21.5, P 25.0 mug/l at any time regained consciousness. Addition of NSE to GCS and somatosensory evoked potentials increased predictability of poor neurological outcome from 64% to 76%. Conclusions: High serum NSE levels in comatose patients at 24 h and 48 h after CPR predict a poor neurological outcome. Addition of NSE to GCS and somatosensory evoked potentials increases predictability of neurological outcome.