儿童院内心肺复苏结局及分析  

Characteristics and outcome of pediatric in-hospital cardiopulmonary resuscitation

作　　者：张欣[1] 李星[1] 王颖[1] 

机构地区：[1]北京大学第一医院儿科,100034

出　　处：《中国小儿急救医学》2013年第6期580-583,共4页Chinese Pediatric Emergency Medicine

基　　金：首都医学发展基金（2007-1031）

摘　　要：目的 研究医院内心肺复苏（cardiopulmonary resuscitation,CPR）的发生及结局,并分析需要CPR患儿的预后,以提高CPR的成功率.方法 应用Utstein模式登记表对2008年10月至2011年10月我院需要CPR且年龄＞28 d的患儿进行前瞻性研究,以自主循环恢复（returning of sponta-neous circulation,ROSC）＞ 24 h为近期预后（复苏成功）的评价标准,对于出院患儿,在出院后6个月应用小儿脑功能类别量表进行脑功能评价.结果 需要CPR患儿共36例,其中ROSC＞ 24 h共15例,占需要CPR患儿的41.7％,存活至出院共7例,占需要CPR患儿的19.4％.单因素分析ROSC＞ 24 h组患儿在起始心脏节律、是否需要除颤及合并基础疾病方面与ROSC＜ 24 h组差异有统计学意义（P＜0.05）,ROSC ＞24h组起始心脏节律以窦性心动过缓为主,在CPR中如需要进行除颤则预后欠佳,基础疾病为心脏病患儿预后不佳;对出院患儿随访除1例失访外,4例患儿脑功能评分在2级以下,4级及5级各1例.结论 我院院内CPR成功率与发达国家报道类似,起始节律、是否需要除颤及合并基础疾病影响近期预后,CPR患儿能够存活则神经系统预后相对较好.Objective To investigate the present situation and outcome of cardiopulmonary resuscitation （CPR） for pediatric in-hospital cardiopulmonary arrest and to analyze the prognostic risk factors.Methods Data were collected from October 2008 till October 2011 using Ustein style.Patients older than 28 days who received CPR were evaluated.Returning of spontaneous circulation（ROSC） more than 24 hours was the primary outcome.Neurological outcome was assessed by pediatric cerebral performance categories half year after discharge.Results Of the 36 patients,15 （41.7％） achieved sustained ROSC.Seven （19.4％） patients survived to discharge.Single factor analysis indicated that the beginning heart rhythm,defibrillation and original disease were significantly different between the two groups（P ＜0.05）.The beginning heart rote of the patient in ROSC ＞ 24 h group was mostly sinus bradycardia.Patients who need defibrillation had bad prognosis.Patients with heart disease had a lower rate of ROSC ＞ 24 h.At half year follow-up study,4 patients had 1 or 2 score,1 patient had 4 and 1 had 5 score in the pediatric cerebral performance categories scales.Condusion The successful rate of CPR in our hospital was the same as that in developed country.The beginning heart rhythm,defibrillation and original disease were associated with the outcome.Most of the patients who survived to discharge had a good neurological outcome.

关 键 词：心跳呼吸骤停 心肺复苏 预后 

分 类 号：R720.597[医药卫生—急诊医学]