对心搏骤停院前救治中值得思考的几个问题的分析  

Pre-hospital Cardiac Arrest Rescue:Some Questions Worth Thinking about

作　　者：张晓凡 林长春 杜贵进 

机构地区：[1]江苏省无锡市急救中心,214023

出　　处：《中国全科医学》2014年第5期555-558,共4页Chinese General Practice

基　　金：无锡市科技发展指导性计划(社会发展)项目(CSZ00N1125)

摘　　要：目的探讨心搏骤停院前救治过程中可能被忽视的因素。方法按照Utstien模式对2010年1月—2012年6月无锡市急救中心接诊的2 946例心搏骤停患者的病历资料进行登记,院前实际救治心搏骤停患者1 759例,用自主循环恢复(ROSC)评估复苏效果。结果性别、年龄、急救反应时间对ROSC率的影响无统计学意义(P>0.05);发病地点、心电图表现、第一目击者是否行CPR、救治方式对ROSC率的影响有统计学意义(P<0.05)。医疗优先分级调度系统(MPDS)启用前后对第一目击者行CPR的影响有统计学意义(χ2=100.96,P<0.05)。MPDS指导对心搏骤停患者ROSC率的影响无统计学意义(χ2=0.68,P>0.05)。结论边救边送至医院不利于心搏骤停患者ROSC,现场充分复苏可以提升复苏成功率;MPDS指导可以提高第一目击者行CPR率。在今后实施复苏过程中,除关注反应时间以外更应关注救治方式和MPDS指导对复苏成功的影响。Objective To explore the probably - neglected factors in pre - hospital cardiac arrest （ CA ） rescue. Methods The data of 2 946 CA patients admitted to this center from January 2010 to June 2012 were recorded according to Ut- stien mode. A total of 1 759 patients had pre - hospital rescue actually. The effects were evaluated by restoration of spontaneous circulation （ROSC）. Results There was no significant difference in effects of gender, age, emergency response time on ROSC rate （P 〉 0. 05）. There was difference in effects of onset locations, ECG, CPR performance by the first witness on ROSC rate （ P 〈 0. 05 ）. There was difference in effects of pre - or post - starting - using classification of medical priority dispatch system （MPDS） on CPR performance by the first witness （ X2 = 100. 96, P 〈 0.05 ）. There was no difference in effect of MPDS guid- ance on ROSC rate （ X2 = 0. 68, P 〉 0. 05 ）. Conclusion CPR during transferring to hospital is not conducive to ROSC of CA patients. Full recovery on scene can improve the success rate of CPR. MPDS guidance can improve the CPR performance by the first witness. More attention should be paid to the effects of rescue methods and MPDS guidance besides response time in CPR performance.

关 键 词：急救医疗服务 心脏停骤 心肺复苏术 医疗优先调度系统 

分 类 号：R541.78[医药卫生—心血管疾病]