急诊科心搏骤停患者心肺复苏预后的影响因素  

Factors influencing outcomes after cardiopulmonary resuscitation in emergency department

作　　者：薛继可[1,2] 冷巧云[3] 高玉芝[3] 陈寿权[1,2] 李章平[1] 李惠萍[1] 黄唯佳[1] 程俊彦[1] 章杰[1] 何爱文[1] 

机构地区：[1]温州医学院附属第一医院急诊科,浙江省温州325000 [2]温州医学院附属第二医院 [3]温州医学院

出　　处：《中华急诊医学杂志》2013年第1期28-34,共7页Chinese Journal of Emergency Medicine

基　　金：温州医学院重大科研项目（yxyzd-B2005-03）;浙江省大学生创新创业项目（2008年度）

摘　　要：目的探讨急诊科心搏骤停（CA）患者心肺复苏（CPR）预后的相关影响因素。方法按Utstein模式要求登记温州医学院附属第一医院急诊科2005年1月至2011年12月期间的CPR病例，比较不同因素分组的CPR效果，对可能影响CPR预后的相关因素进行单因素和多因素Logistic回归分析。结果725例CPR病例中，自主循环恢复（ROSC）、24h存活、出院存活、神经功能良好出院存活分别为187例（25．8％）、100例（13．8％）、48例（6．6％）、23例（3．2％）。创伤性、首次监测心律、CPR持续时间、肾上腺素使用剂量是影响ROSC的独立预测因素；创伤性、心源性、首次监测心律、CPR持续时间是影响24h存活的独立预测因素；CA前状态、心源性、首次监测心律、CPR持续时间是影响出院存活和神经功能良好出院存活的独立预测因素。结论可除颤心律、CPR持续时间≤15min、肾上腺素使用剂量≤5mg是影响ROSC的有利因素，创伤性是不利因素。心源性、可除颤心律、CPR持续时间≤15rain是24h存活的有利因素，创伤性是不利因素。心源性、可除颤心律、CPR持续时间≤15min是出院存活和神经功能良好出院存活的有利因素，CA前为疾病终末期／多脏器功能衰竭（MOF）是不利因素。Objective To assess the factors impacting outcomes of cardiopulmonary resuscitation （CPR） after cardiac arrest （CA） in department of emergency. Methods A CPR registry followed the Utstein template was carried out in Department of Emergency of The First Affiliated Hospital of Wenzhou Medical College from January 2005 through December 2011. The outcomes of CPR were compared among groups with various factors. The primary outcomes were rates to return of spontaneous circulation （ROSC）, 24-hour survival, survival at discharge and survival without neurological deficit at discharge. Univariate and multivariable logistic regression analysis were performed to evaluate factors associated with survival. Results A total of 725 patients with CPR attempts were enrolled for analysis. Of them, 187 （25.8%） had ROSC, 100 （13.8%） survived over 24 hours, 48 （6. 6%） survived to discharge, and 23 （3.2%） survived to discharge with favorable neurologic outcome. From a logistic regression analysis, the independent predictors of ROSC included traumatogenic CA, kind of cardiac rhythms observed at first monitoring, CPR duration and total adrenaline dose. The independent predictors of 24-hour survival included traumatogenic CA, cardiogentic CA, kind of cardiac rhythm found at first monitoring and CPR duration. Physical status before CA, cardiogenic CA, kind of cardiac rhythms appeared at first monitoring and CPR duration were independent predictors of survival at discharge and survival with neurologically intact function at discharge.Conclusions Cardiac fibrillation rhythms correctable with defibrillation, CPR duration ≤ 15 min and total adrenaline dose ≤ 5 mg were favorable predictors of ROSC, while traumatogenic CA was unfavorable. Cardiogenic CA, cardiac fibrillation rhythms rectifiable with defibrillation and CPR duration ≤ 15 min were favorable predictors of 24-hour survival, while traumatogenic CA was unfavorable, traumatogenic CA, cardiac dysrhythmia correctable, CPR duration ≤ 15 min were favorabl

关 键 词：心搏骤停 心肺复苏 UTSTEIN模式 LOGISTIC回归分析 预后 

分 类 号：R459.7[医药卫生—急诊医学]