深圳市院外心脏骤停流行病学特点及复苏效果分析  

Epidemiological Characteristics and Analysis of Resuscitation Effect forOut-of-hospital Cardiac Arrest in Shenzhen under the Utstein Model

作　　者：许波 何晴 朱虹 侯剑锋 周强 XU Bo;HE Qin;ZHU Hong;HOU Jian-feng;ZHOU Qiang(Shenzhen Center for Prehospital Care,Shenzhen,518036)

机构地区：[1]广东省深圳市急救中心,518036

出　　处：《岭南急诊医学杂志》2020年第3期217-220,共4页Lingnan Journal of Emergency Medicine

基　　金：广东省医学科研基金立项项目(B2018115)。

摘　　要：目的:分析深圳市院外心脏骤停(OHCA)流行病学特征和影响院前复苏成功的因素,探索本地区现阶段如何提高OHCA复苏成功率。方法:参照Utstein模式,收集2017年1月至2019年5月深圳市急救中心调度的所有OHCA并行CPR的患者临床资料,回顾性分析其发生年龄、性别、时间、地点、病因、急救反应时间、初始心律、有无目击者、目击者CPR、AED使用、院前高级生命支持情况等流行病学特征,分为复苏有效组和复苏无效组,比较OHCA院外生存链关键环节对两组患者生存率的影响,分析影响院前复苏成功的因素。结果:本研究共纳入1893例OHCA患者,男1385例(73.16%),女508例(26.84%),平均年龄(54.17±20.01)岁,复苏成功率为8.87%。OHCA发生时间主要集中在17-24点,以20-22点最甚,住宅发生率最高(66.77%),其次分别为娱乐场所(9.19%)、交通枢纽(7.03%)、工作场所(6.18%)、学校(4.07%)、体育场馆(1.64%)和公园(1.43%)等。OHCA病因主要为心源性疾病(39.51%),其次为创伤(9.09%)、呼吸系统(8.77%)等。OHCA初始心律表现为大多数是不可除颤心律(95.62%),OHCA平均急救反应时间为(9.23±6.29)分,37.51%的OHCA有目击者,但目击者实施CPR及AED率仅为2.32%和0.63%。在OHCA院前高级生命支持中,肾上腺素使用率(52.4%)远高于气管插管率(10.99%)。与复苏无效组比较,院前ROSC组在平均年龄、OHCA发生地点、病因、初始心律、急救反应时间、目击者CPR及AED、肾上腺素的使用方面差异有统计学意义(P<0.05)。结论:深圳市OHCA在流行病学上形成了一定的区域特点,院前复苏成功率的提高有赖于进一步完善院外生存链的各个关键环节,构筑全民急救体系。Objective:To analyze the epidemiological characteristics of patients with out-of-hospital cardiac arrest(OHCA)in shenzhen and the factors affecting the success of pre-hospital resuscitation,and to explore how to improve the success rate of OHCA resuscitation in this region. Methods:Using the Utstein model to collect all clinical data of OHCA patients given CPR dispatched by shenzhen center for prehospital care from January 2017 to May 2019,and retrospectively analyzethe epidemiological characteristics of age,gender,time,place,cause,emergency response time,initial heart rhythm,witnessed or not,bystander CPR and AED,and advanced life support. These cases were divided into effective recovery and recovery invalid group,comparing the chain of survival key impact on the survival rate of two groups,analysis of influence factors in the success of the pre-hospital recovery. Results:A total of 1893 OHCA patients were included in this study,including 1385 male patients(73.16%) and 508 female patients(26.84%),with an average age of(54.17±20.01)years old,and a success rate of resuscitation of 8.87%. OHCA occurs mainly at 17-24 points,with the highest incidence at 20-22 points,and the highest incidence in dwelling places(66.77%),followed by entertainment places(9.19%),transportation hubs(7.03%),workplaces(6.18%),schools(4.07%),sports venues(1.64%)and parks(1.43%). The causes of OHCA were mainly cardiac diseases(39.51%),followed by trauma(9.09%) and respiratory system(8.77%). The initial heart rate of OHCA was mostly non-defibrillating(95.62%),the average emergency response time of OHCA was 9.23±6.29 points,and 37.51% of OHCA had witnesses,but the CPR and AED rate of bystanders was only 2.32% and 0.63%. In prehospital advanced life support,the rate of epinephrine utilization(52.4%)was much higher than that of endotracheal intubation(10.99%).Compared with the non-resuscitation group,the pre-hospital ROSC group showed statistically significant differences in mean age,location,etiology,initial heart rate,emergency response time,

关 键 词：UTSTEIN模式 心脏骤停 心肺复苏 生存链 自主循环恢复 流行病学 

分 类 号：R541.78[医药卫生—心血管疾病] R181.3[医药卫生—内科学]