117例院前心脏骤停患者心肺复苏后自主循环恢复及出院存活率相关因素分析  

Analysis of related factors of ROSC and discharge survival rate in 117 pre - hospital cardiopulmonary resuscitation eases in Shanghai

作　　者：李明华[1] 许臻晔[2] 蒋婕[2] 陆峰[1] 许萍[1] 叶继 叶静[2] 陆一鸣[2] 

机构地区：[1]上海市医疗急救中心科教部,上海200233 [2]上海交通大学医学院附属瑞金医院北院急诊科,上海201821

出　　处：《中国急救医学》2017年第7期603-606,共4页Chinese Journal of Critical Care Medicine

基　　金：上海市卫生和计划生育委员会科研项目（201540322）

摘　　要：目的分析院前心脏骤停（CA）患者心肺复苏（CPR）后自主循环恢复（ROSC）与存活出院的相关影响因素，为提高院前复苏成功率提供依据。方法对院前CPR成功的117例CA患者进行跟踪随访及回顾，对相关影响因素进行统计分析。结果①117例院外CA数据分析：出院组11例，ROSC后死亡组106例，存活出院率9．4％。②与死亡组比较，出院组心源性疾病，有进行目击者CPR、急救反应时间〈4rain等因素差异有统计学意义（均P〈0．05）；复苏前心律[室颤／室速（VF／VT）]，出院组明显高于死亡组（P〈0．01）；急救反应时间、心肺复苏时间、肾上腺素剂量与出院成功率呈明显负相关；复苏后心律变化与除颤次数差异无统计学意义（P〉0．05）；使用球囊面罩通气较气管插管通气两组之间差异有统计学意义（P〈0．05），出院组患者插管率明显低于死亡组（P〈0．01）。结论VF／VT、急救反应时间和复苏时间长短可能是影响院前CPR成功率及出院存活率的重要因素；低剂量肾上腺素与球囊通气可能有利于提高院前CPR出院成功率。Objective To analyze the related factors of restoration of spontaneous circulation （ROSC） and survival ratio after cardiopulmonary resuscitation （CPR） in pre - hospital cardiac arrest patients, and to provide evidence for improving the success rate of pre - hospital resuscitation. Methods We followed up and retrospectively analyzed 117 successful resuscitation cases of pre -hospital cardiac arrest and statistically analyzed the related influencing factors. Results 11 cases （9.4%） were survival and discharged from the hospital while 106 cases died after ROSC. There were significant differences （P 〈 0.05 ） in cardiogenic disease, Witness - CPR, less than 4 min first aid response time between the discharge group and the death group. Fact of VF/VT before resuscitation in discharge group was significantly higher than that in death group（P 〈 0.01 ）. First aid response time, duration of CPR and adrenaline dose had negative correlation with the discharge rate. There was no statistical difference in cardiac rhythm after resuscitation and defibrillation times. There was a statistically significant difference between using mask ventilation and endotracheal intubation who has lower discharge rate. Conclusion VF/VT before resuscitation, first aid response time and duration of CPR may be important factors affecting the success rate of pre - hospital cardiopulmonary resuscitation and the rate of hospital discharge. Patients with low doses of epinephrine and mask ventilation may have an ideal prognosis forresuscitation.

关 键 词：心肺复苏(CPR) 院前急救 影响因素 出院率 自主循环恢复(ROSC) 心脏骤停(CA) 

分 类 号：R541.78[医药卫生—心血管疾病]