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目的:探讨凝血/纤溶改变对成人体外心肺复苏（extracorporeal cardiopulmonary resuscitation, ECPR）患者神经功能预后的预测价值。方法:纳入2018年1月至2023年4月于南京医科大学第一附属医院急诊科接受ECPR治疗的心脏骤停（cardiac arrest, CA），体外膜肺氧合建立后立即采集静脉血，测定血小板计数（platelet, PLT）及凝血功能相关指标，包括凝血酶原时间（prothrombin time, PT）、活化部分凝血活酶时间（activated partial thromboplastin, APTT）、凝血酶时间（thrombin time, TT）、纤维蛋白原（fibrinogen, Fib）和D-二聚体（D-dimer, D-D），评价各指标对神经功能不良预后（CPC评分3~5分）的预测价值。结果:研究共纳入133例患者，预后不良患者96例，占72.2%。与预后良好组比较，预后不良组PLT、Fib水平显著降低，PT、APTT显著延长（均 P<0.05）。ECPR患者PT（ HR=1.87，95% CI:1.17~2.99， P=0.009）、APTT（ HR=1.95，95% CI:1.26~3.00， P=0.003）和D-D（ HR=5.18，95% CI:2.06~13.03， P<0.001）高水平组神经功能不良预后风险显著高于低水平组。PLT（ HR=0.55，95% CI:0.35~0.84， P=0.007）高水平组神经功能不良预后风险显著低于低水平组。 结论:ECPR患者凝血/纤溶改变可作为预测神经功能预后不良的有效手段。

Objective:To evaluate the prognostic value of coagulofibrinolytic changes in survivors of adult extracorporeal cardiopulmonary resuscitation (ECPR) in Chinese.Methods:133 cardiac arrest (CA) patients whose blood samples were collected after establishment of extracorporeal membrane oxygenation between January 2018 and April 2023 in Emergency Department of the First Affiliated Hospital of Nangjing Medical University were enrolled in this single-center study. The following were examined: platelet counts (PLT), prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT), fibrinogen (Fib), and D-dimer (D-D). The prognostic values of these coagulation-related indicators in predicting poor outcomes (Cerebral Performance Category 3-5) were analyzed.Results:Among the 133 patients involved, 96 (72.2%) had poor outcomes after ECPR treatment. In the poor-outcome group, PLT and Fib were significantly decreased, while PT and APTT were significantly prolonged (all P < 0.05). ECPR survivors had a significantly higher risk of poor neurological outcomes in the high-level group than those in the low-level group for PT ( HR=1.87, 95% CI:1.17-2.99, P=0.009), APTT ( HR=1.95, 95% CI:1.26-3.00, P=0.003), and D-D levels ( HR=5.18, 95% CI:2.06-13.03, P<0.001). The risk of poor neurological outcomes was significantly lower in the high-level group for PLT ( HR=0.55, 95%CI:0.35-0.84, P=0.007). Conclusion:Coagulofibrinolytic changes can be promising tools to assess poor neurological outcomes in adult ECPR survivors.