对院前心肺复苏效果影响的多因素分析  

Binary logistic regression analysis of the factors influencing the efficacy of pre-hospital CPR

作　　者：梁实 陈清[2] 张文武[3] 张豪 周文 肖建鹏 陈宏标 贾清旺[5] 赵小斐[3] 余益民[3] 

机构地区：[1]深圳市滨海医院,广东省深圳518053 [2]南方医科大学流行病学系 [3]深圳市宝安区人民医院 [4]深圳市观澜医院 [5]深圳市急救中心

出　　处：《中华急诊医学杂志》2010年第1期21-25,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨影响心肺复苏（cardiopulmonary resuscitation，CPR）效果的独立影响因素。方法研究对象为做过CPR的1376例心搏骤停（cardiac arrest，CA）患者，行回顾性调查，用EpiData软件建数据库，用SPSS13．0软件行两分类Logistic回归分析，选取变量为单因素分析有意义的影响CPR效果的因素。结果对恢复自主循环（return of spontaneous circtdation，ROSC）——第一目击者急救是保护因素，OR=2．21（P〈0．01，95．0％CI=1．356．3．602）；与女性比较男性是危险因素，OR=0．515（P〈0．01，95．0％CI=0．320～0．826）；20～29岁组较≥81岁组ROSC可能性大，OR=3．241（P〈0．05，95．0％CI=1．146～9．138）；CPR术前心跳骤停时间是危险因素，OR=0．913（P〈0．01，95．0％CI=0．887。0．948）；与心脏静止比较，室颤是保护因素，OR=5．092（P〈0．01，95．0％CI=2．927～8．861）；电击是保护因素，OR=3．384（P〈0．01，95．0％C／=2．033～5．635）；肾上腺素0～4mg组ROSC可能性高于≥5mg组，OR=3．255（P〈0．01，95．0％CI=1．606～6．597）。对生存到院——2～12岁和13～19岁组生存到院可能性分别比≥81岁组高，OR=12．818（P〈0．05，95．0％CI=1．299～126．508）和OR=10．505（P〈0．05，95．0％CI=1．161-95．058）；CPR前CA时间是危险因素，OR=0．862（P：〈0．01，95．0％CI=0．821～0．906）；室颤患者生存到院的可能性较心脏静止患者高，OR=7．330（P=〈0．01，95．0％CI=3．962～13．560）。结论院前CA患者ROSC的独立影响因素有CPR前ECG、第一目击者急救、电击、CPR前CA时间、肾上腺素剂量、性别、年龄分组。院前CA患者生存到院独立影响因素有CPR前ECG、CPR前CA时间、年龄分组。Objective To investigate the independent factors influencing the efficacy of pre-hospital CPR effect. Method The data base with 1376 cases was set up with EpiData software by means of questionnaires and the information was provided by the survivals from eardiopulmonary arrest（CA） saved with cardiopulmonary resuseitation（CPR）, and the data were analyzed with SPSS 13.0 software to carry out binary logistic regression. Through single factor analysis, the factors with emerged statistical significance were chosen as variances. Results With regard to the restoration of spontaneous circulation （ROSC）, the rescue did by the first witness was the protective factor （PF） （OR = 2.21, P = 0.001, 95.0% CI = 1.356- 3.602）; the male was the risk factor （RF） contrasted with the female （ OR = 0. 515, P = 0. 006, 95.0% CI = 0. 320 - 0. 826） ; ages between 20 and 29 years old had higher likelihood of ROSC than group 1〉81 years old （ OR = 3.241, P = 0.026, 95.0%CI = 1. 146 - 9. 138） ; the length of CA time before CPR was RF （ OR = 0. 913, P = 0. 000, 95.0% CI = 0. 887 - 0. 948） ; ventricular fibrillation （VF） was PF compared with asystole （ OR = 5.092, P = 0.000, 95.0%CI = 2.927 - 8. 861 ）; electric shock was PF （OR = 3. 384, P = 0. 000, 95.0% CI = 2. 033 - 5. 635）; epinephrine dosage 0 - 4 mg had higher likelihood of ROSC than 〉 5 nag dosage （ OR = 3. 255, P = 0. 001, 95.0% CI = 1. 606 - 6. 597）. In respect of probability about victims at the time reached hospital alive, ages of 2- 12 and 13 - 19 years old had higher rations than /〉81 years old （OR = 12.818, P = 0.029, 95.0% CI = 1.299 - 126.508）（OR = 10.505, P = 0.036, 95.0% CI = 1. 161 - 95.058） ; the length of CA time before CPR was RF （ OR =0.862, P = 0.000, 95.0%CI = 0.821 - 0.906）; VF was PF compared with asystole （OR = 7.330, P = 0.000, 95.0%CI = 3.962 - 13.560）. Conclusions ECG change before CPR, rescue by the first witness, electric shock, the length of CA time before CPR, epinephrine dosage, gender a

关 键 词：院前急救 心搏骤停 心肺复苏 LOGISTIC回归 

分 类 号：R459.7[医药卫生—急诊医学]