影响院前急救心肺复苏成功的因素及提升策略分析  

Analysis on successful influencing factors and promotion strategies of cardiopulmonary resuscitation in prehospital medical emergency rescue

作　　者：赵彦叶 顾乃刚[1] Zhao Yanye;Gu Naigang(Tianjin Emergency Center,Tianjin 300011,China)

机构地区：[1]天津市急救中心,天津300011

出　　处：《中国中西医结合急救杂志》2021年第2期154-158,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨院前急救对院外心搏骤停(OHCA)患者心肺复苏(CPR)成功率的影响因素,分析提升CPR成功率的院前医疗急救体系建设策略.方法回顾性分析2018年7月1日至2020年6月30日天津市急救中心接诊的OHCA行CPR患者的资料,根据是否有自主循环恢复(ROSC)分为ROSC组和非ROSC组.收集患者的性别、年龄、发病地点、基础疾病、第一目击者、优先分级调派系统(MPDS)指导CPR、急救反应时间、首次心电图心律类型、实施CPR医生性别及现场处置方式等资料并进行单因素分析,然后将单因素分析中P≤0.1的指标纳入多因素二元Logisitic回归分析.同时对比分析天津市急救中心近两年院前医疗急救资源投入增加前后OHCA患者CPR成功率的变化.结果共纳入151例患者,男性106例,女性45例;年龄15~92岁,平均(63.03±16.20)岁;ROSC患者60例,非ROSC患者91例.151例患者中,发病地点多在家庭(占80.8%),且90.7%患者发病时有第一目击者,54.3%基础疾病为心源性疾病,MPDS调度电话指导第一目击者CPR占43.0%;平均急救反应时间为(15.47±11.84)min;首次心电图心律类型主要为心脏停搏(占58.3%),其次为无脉性室性心动过速或心室纤颤(占26.5%)和室性自主心律(占15.2%);实施CPR的医生多为男性(占70.2%);治疗过程中33.1%给予现场除颤,34.4%实施气管插管,60.3%建立静脉通路,45.7%使用肾上腺素.单因素分析显示,两组间性别、年龄、发病地点、基础疾病、第一目击者、MPDS指导CPR、平均急救反应时间、实施CPR医生性别、建立静脉通路、呼吸支持方式等因素比较差异均无统计学意义(均P>0.05),而两组间急救反应时间<14 min或<5 min、首次心电图心律类型、现场除颤、使用肾上腺素等因素比较差异均有统计学意义(均P<0.05).将单因素分析中P≤0.1的指标纳入多因素二元Logisitic回归分析,结果显示,急救反应时间<5 min〔优势比(OR)=0.117,95%可信区间(95%CI)为0.330~0.Objective To explore the influencing factors of prehospital emergency system on the success rate of cardiopulmonary resuscitation(CPR)in patients with outside of hospital cardiac arrest(OHCA),and to analyze the construction strategy of pre-hospital medical emergency system to improve the success rate of CPR.Methods The data of patients with OHCA undergoing CPR in Tianjin Emergency Center from July 1,2018 to June 30,2020 were retrospectively analyzed,and according to the presence or absence of return of spontaneous circulation(ROSC),they were divided into ROSC group and non ROSC group.The data of patients'gender,age,place of onset,underlying disease,first witness,medical priority dispatch system(MPDS)guiding CPR with gradation,emergency response time,first electrocardiogram(ECG)cardiac rhythm type,gender of CPR doctors,on-site treatment methods,etc.were collected for univariate analysis,and then the indexes with statistical significant differences(P≤0.1)in the above analysis were included in the multivariate binary Logistic regression analysis.At the same time,the changes of CPR success rate of OHCA patients before and after the increase of pre-hospital medical emergency resources in recent two years in Tianjin Emergency Center were compared and analyzed.Results A total of 151 patients were enrolled,including 106 males and 45 females;aged 15-92 years old,average of(63.03±16.20)years old;there were 60 patients with ROSC and 91 patients without ROSC.In the 151 patients,most of them with cardiac arrest occurred at home(80.8%),and 90.7%of the patients had the first witness,54.3%of the basic diseases were cardiogenic diseases,and 43.0%of the first-witness had CPR under the guidance of MPDS dispatching telephone;the average emergency response time was(15.47±11.84)min;the main cardiac rhythm type of the first ECG was cardiac arrest(58.3%),followed by ventricular fibrillation or pulseless ventricular tachycardia(26.5%)and idioventricular rhythm(15.2%);most of the CPR doctors were male(70.2%),in the therapeutic process

关 键 词：院外心搏骤停 心肺复苏 自主循环恢复 院前急救 

分 类 号：R47[医药卫生—护理学]