2013至2016年上海市心室纤颤患者院前急救分析  

Analysis of out-of-hospital emergency treatment for ventricular fibrillation between 2013 and 2016 in Shanghai

作　　者：李幸祥[1] 腾飞跃 许萍[1] 李明华[1] 柳融皎 方萍[3] 胡佳文[4] Li Xingxiang Teng Feiyue Xu Ping Li Minghua Liu Rongjiao Fang Ping Hu Jiawen(Department of Emergency, Shanghai Medical Emergency Center, Shanghai 200030,Chin Department of Gerontology, Shanghai Eighth People＇s Hospital, Shanghai 200235, China Department of Endocrinology, Tongji Hospital, Tongfi University, Shanghai 200065, Chin Department of Emergency, Tongji Hospital, Tonal University, Shanghai 200065, Chin)

机构地区：[1]上海市医疗急救中心急救科,200030 [2]上海市第八人民医院老年科,200235 [3]同济大学附属同济医院内分泌代谢病科,上海200065 [4]同济大学附属同济医院急诊科,上海200065

出　　处：《中华危重病急救医学》2017年第10期871-876,共6页Chinese Critical Care Medicine

基　　金：上海市卫生计生委重要薄弱学科建设项目（2016ZB0204）

摘　　要：目的 分析上海市心室纤颤（室颤）患者院前急救现状及复苏相关因素,探讨提高复苏成功率的相关措施.方法 回顾性分析2013年1月至2016年12月上海市医疗急救中心接诊的院外室颤患者资料,收集患者的一般临床资料、院前急救时间、院前复苏及最终复苏情况,用Logistic回归分析复苏成功相关的因素.结果 2013至2016年上海市医疗急救中心接收可疑心源性心搏骤停患者21096例,室性心动过速（13例）、心室停搏（20995例）患者均予排除,最终纳入88例院前室颤患者,其中男性62例,女性26例;年龄（63.22±16.15）岁;目击者行心肺复苏（CPR）者仅21例（占23.86％）;白天（08：00至20：00）呼救57例,夜间呼救31例;急救中心接到求救电话至急救人员到达现场的时间（响应时间）为（6.47±4.13）min,急救人员到达现场至离开现场的时间（现场时间）为（14.76±10.88）min,急救人员离开现场至到达医院急诊的时间（转运时间）为（5.95±4.00）min,4年间以及白天与夜间的院前急救时间差异均无统计学意义.2013至2016年院前复苏成功率逐年降低〔分别为95.65％（22/23）、87.50％（14/16）、83.33％（20/24）、80.00％（20/25）,χ2=1.895,P=0.595〕,最终复苏成功率逐年升高〔分别为21.74％（5/23）、31.25％（5/16）、37.50％（9/24）、40.00％（10/25）,χ2=2.862,P=0.413〕.进行1次、2次、≥3次除颤的室颤患者院前复苏成功率分别为35.23％（31/88）、23.08％（12/52）、89.19％（33/37;χ2=42.811,P=0.000）,说明多次除颤可显著增加院前复苏成功率.最终复苏成功组现场时间明显短于未成功组（min：10.85±8.83比16.79±11.36,t=2.367,P=0.020）,心电监护仪记录室颤至恢复室上性心律的时间（复苏成功用时）明显短于未成功组（min：3.24±3.17比7.43±6.64,t=3.175,P=0.002）,说明用时越短,最终复苏成功率越高.Logistic回归分析显示,复苏成功用时长是院Objective To investigate the epidemiological features of out-of-hospital patients with ventricular fibrillation （VF） in Shanghai and to analysis factors associated with outcomes, and to provide evidence for improving the success rate of VF.Methods The data of patients with VF admitted to Shanghai Medical Emergency Center from January 2013 to December 2016 were analyzed retrospectively. All the data were recorded including the clinical data, medical service time, return of spontaneous circulation （ROSC） at scene/en route, survival to hospital discharge. Factors that associated with successful resuscitation were analyzed by Logistic regression.Results From 2013 to 2016, 21096 patients with suspected cardiac arrest were admitted to the Shanghai Medical Emergency Center. After excluding ventricular tachycardia （13 cases） and ventricular asystole （20995 cases）, 88 patients with VF were enrolled, with 62 male and 26 female; the average age was （63.22±16.15） years old. While bystander cardiopulmonary resuscitation （CPR） was performed in only 21 cases （23.86%）. Fifty-seven cases occurred during the day （08：00-20：00）, while 31 cases occurred in the night. And the average emergency response time was （6.47±4.13） minutes; the average on-site time was （14.76±10.88） minutes; the average transport to hospital time was （5.95±4.00） minutes. There were no significant differences in response time, on-site time and transport to hospital time each year, and there were no significant differences in emergency medical service time between day and night either. From 2013 to 2016, prehospital successful resuscitation rate was decreased by years [95.65% （22/23）, 87.50% （14/16）, 83.33% （20/24） vs. 80.00%（20/25）, respectively,χ2 = 1.895,P = 0.595]. Survival to hospital discharge rate was increased by years [21.74% （5/23）, 31.25% （5/16）, 37.50% （9/24）, 40.00% （10/25）, respectively,χ2 = 2.862,P = 0.413]. The success rate of prehospital resuscitation for patie

关 键 词：院外心搏骤停 心室纤颤 院前急救 

分 类 号：R541.75[医药卫生—心血管疾病]