The Clinical Evaluation About Glasgow Coma Scale On Clinical Prognosis Of Post-cardiac Arrest Syndrome Patients

The body occurred strong stress response,nervous,endocrine,vasoactive drugchanges after cardiac arrest,then tissue ischemia/reperfusion injury, may lead tosystemic inflammatory response syndrome(SIRS),and multiple organ dysfunctionsyndrom,the processes are known as the post-cardiac arrest syndrome.Post–cardiacarrest syndrome is a unique and complex combination of pathophysiologicalprocesses, which include (1) post–cardiac arrest brain injury,(2) post–cardiac arrestmyocardial dysfunction, and (3) systemic ischemia/reperfusion response.Brain is themost sensitive to systemic ischemia,the most successful resuscitation of cardiacarresr patients are in disturbance of consioueness,some are in a vegetative state,andthe survival patients accompanied by neurological impairment need to strengthenfurther treatment,which has brought a heavy burden to heaithcare system,the familiesof patients and the whole society.Therefore,the neural function recovery is the mostimportant link in cardiopulmonary resuscitation.A recent study showed thatprognostication based on neurological examination anddiagnostic modalitiesinfluenced the decision of physicians can detemine the support treatment time ofpatients.Because of Gasgow coma score is simple and easy to master,it can judge theprognosis cccording to different times of score and the changes.Objective: Explore the value of Gasgow coma score to evaluate the never functionand long-term prognosis in the post-cardiac arrest syndrome patients.So as to establisha set of digital method to assess the severity level of disturbance of consciouness andto predict the prognosis.Methods: We analyzed89cardiac arrest patients retrospectively who weresuccessfully resuscitated,Both of them were given comprehensive treatmentincluding correct the cause, circulation support, mechanical ventilation, mildhypothermia, infection control and so on.,at the same time,record the basic data of patients.They were divided into two groups,The good neurological function prognosis group and poor prognosis group.Weanalysed and compared two group of basic data,clinical features and differenttime’s Glass coma score and so on,to explore the relationship between the index andthe prognosis,seeking for the a well index which reflect to the injury degree andprognosis of brain.Results:1.There were no significant difference between the groups of patients ingender,age,primary disease,previous history of cardiovascular disease,cardiac arrestplace,reason,initial rhythm(p>0.05);but the groups in CPRtime,mechanical ventilationtime and acute physiology and chronic heaih evaluation(APACHE II) have obviousdifference,and the difference has statistical significance(p<0.05).2.The third days and fifth days of GCS scale and GCS scale in theeyes,language,motor score have obvious difference,and the difference has statisticalsignificance(p<0.05).3.The third days of GCS scale in the eyes,motor score is lower of two groups ofpatients recovery,then the patients of90days neual functional prognosis is more likelypoor.and fifth days verbal score also have statistical difference(p<0.05).4.The fifth days of GCS score has higher predictive accuracy(area under theROC curve is maximum,0.921),the senstiivity and specificity were97.1%,20%;thearea under the ROC curve for the third days GCS scale was greater than0.9,then theprediction accuracy is higher,the senstiivity and specificity were100%,21.8%;thearea under the ROC curve for the24hours APACHE II score was0.726,it also haspredictive value,but the accuracy is poor,the senstiivity and specificity were52.9%and85.5%.5.The7days survival group compared with death group,its fifth days GCS scorewas significantly higher,and the difference has statistical significance(p<0.05);the28days survival group compared with death group,its third and fifth days GCS scorewere statistically significant(p<0.05);but the90days survival group compared with death group,its third and fifth days GCS score were not statisticallysignificant(p>0.05)Conclusion:1. The third and fifth days of GCS scale and GCS scale in the eyes,language,motorscore have a correlation with the prognosis of never function.2. The fifth days of GCS scale has negative relation with the mortality rate of7days,also the third and fifth days of GCS scale have negative relations with themortality rate of28days,but they have no correlation with90day mortality.