影响患者围手术期心肺复苏成功率的因素分析  

Factor analysis for the prognosis of perioperative cardiopulmonary resuscitation

作　　者：费悦[1] 王乐毅[1] 钟泰迪[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院麻醉科,杭州310016

出　　处：《中华医学杂志》2014年第1期18-21,共4页National Medical Journal of China

摘　　要：目的为围手术期实施有效的心肺复苏提供指导作用。方法回顾性分析2005年1月1日至2012年6月1日期间于浙江大学附属邵逸夫医院行手术治疗并在围手术期发生心跳骤停且遵照2005年美国麻醉医师协会（ASA）心肺复苏指南进行积极抢救的病例69例（包括急诊病例）。根据心肺复苏结果分为：复苏成功组（27例）和复苏失败组（42例）。比较两组间年龄、性别、ASA分级、体质指数（BMI）、麻醉类型、心跳骤停发生时间、心跳骤停类型、出血量、心肺复苏持续时间、低血压持续时间、除颤时机、是否合并心血管疾病等因素，将计数资料进行X。检验及Logistic回归检验，分析影响心肺复苏成功率的因素。结果围手术期发生心跳骤停并行心肺复苏病例69例，Logistic分析显示ASA分级Ⅳ-Ⅴ级（P=0．029，OR=1．956，CI：1．226～4．809）、心跳骤停发生在手术室外（P=0．014，OR=1．92，CI=1．478—3．513）、出血量在1500ml以上（P=0．023，OR=1．615，CI=1．245—2．313）、CPR时间持续30rain以上（P=0．003，OR=3．54，CI=3．313—5．007）、低血压时间持续30min以上（P=0．002，OR=2．782，CI：1．791—4．322）、心跳骤停表现为无脉性电活动（P=0．032，OR=1．419，CI=0．146—1．583）。结论ASA分级Ⅳ～V级、心跳骤停发生于手术室外、骤停类型表现为无脉性电活动、出血量〉1500ml、心肺复苏持续时间〉30rain、低血压持续时间〉30rain为心肺复苏失败的危险因素。Objective To provide guidance to implement effective perioperative eardiopulmonary resuscitation. Methods A total of 69 perioperative cardiac arrest patients who received Cardiopulmonary resuscitation according to the 2005 guidelines in Sir Run Run Shaw Hospital from January 2005 to June 2012 were included（ including emergency operation）. According to the results of eardiopulmonary resuscitation, divide these 69 patients in to two groups, Successful resuscitation group（27cases） and failed resuscitation group（42cases）. Compare the age,gender, ASA physical status, BMI, type of anesthesia, time that cardiac arrest occurred, cardiac arrest type, amount of bleeding, CPR duration, hypotension duration, defibrillation time, combined cardiovascular disease between successful resuscitation group and failed resuscitation group, calculate the measurement data for the ehi-square test and logistic regression, derive factors that affect the success rate of eardiopulmonary resuscitation. Results A total of 69 perioperative cardiac arrest patients, according to Logistic regression, ASA IV - V （ P = 0. 029, OR = 1. 956, CI = 1. 226 - 4. 809 ）, amount of bleeding more than 1500 ml （ P = 0. 023, OR = 1. 615, CI = 1. 245 - 2. 313 ） , CPR duration more than 30 rain （P = 0. 003, OR = 3.54, CI = 3. 313 - 5. 007 ） , hypotension duration more than 30 min （ P = 0. 002, OR = 2. 782, CI = 1. 791 - 4. 322）, the type of cardiac arrest is pulseless electrical activity （ P = 0. 032, OR = 1. 419, CI = 0. 146 - 1. 583 ）. Conclusion ASA IV - V, amount of bleeding more than 1500 ml, CPR duration more than 30 min, hypotension duration more than 30 min and pulseless electrical activity are the Independent risk factors of cardiopulmonary resuscitation.

关 键 词：围手术期 心肺复苏 

分 类 号：R459.7[医药卫生—急诊医学]