儿童重症监护病房先天性心脏病患儿心肺复苏效果及预后影响因素分析  

Effect and influence factors of cardiopulmonary resuscitation in children with congenital heart disease in pediatric intensive care unit

作　　者：刘刚[1] 楚建平 陈建丽[3] 钱素云[1] 金丹群 卢秀兰[5] 徐梅先[6] 成怡冰 孙正芸 缪红军[9] 李军[10] 董胜英[11] 丁新 王莹 陈庆 段袁园 黄娇甜[5] 郭艳梅[6] 石晓娜[6] 苏军[7] 尹怡 信晓伟 赵劭懂[9] 娄子轩 蒋敬荟[11] 曾健生[1] Liu Gang;Chu Jianping;Chen Jianli;Qian Suyun;Jin Danqun;Lu Xiulan;Xu Meixian;Cheng Yibing;Sun Zhengyun;Miao Hongjun;Li Jun;Dong Shengying;Ding Xin;Wang Ying;Chen Qing;Duan Yuanyuan;Huang Jiaotian;Guo Yanmei;Shi Xiaona;Su Jun;Yin Yi;Xin Xiaowei;Zhao Shaodong;Lou Zixuan;Jiang Jinghui;Zeng Jiansheng(Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Pediatric Intensive Care Unit,Xian Children′s Hospital,Xi′an 710003,China;Pediatric Intensive Care Unit,Guiyang Maternal and Child Health Care Hospital,Guiyang 550000,China;Pediatric Intensive Care Unit,Anhui Children′s Hospital,Hefei 230000,China;Pediatric Intensive Care Unit,Children′s Hospital of Hunan Province,Changsha 410000,China;Pediatric Intensive Care Unit,Hebei Children′s Hospital,Shijiazhuang 050000,China;Pediatric Intensive Care Unit,Children′s Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China;Pediatric Intensive Care Unit,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250000,China;Emergency Ward/Pediatric Intensive Care Unit,Children′s Hospital of Nanjing Medical University,Nanjing 210000,China;Pediatric Intensive Care Unit,Jinan Children′s Hospital,Jinan 250000,China;Pediatric Intensive Care Unit,Liaocheng People′s Hospital,Liaocheng 252000,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院重症医学科,北京100045 [2]西安儿童医院儿童重症医学科,西安710003 [3]贵阳市妇幼保健院儿童重症医学科,贵阳550000 [4]安徽省儿童医院儿童重症医学科,合肥230000 [5]湖南省儿童医院重症医学科,长沙410000 [6]河北省儿童医院重症医学科,石家庄050000 [7]郑州大学附属儿童医院重症医学科,郑州450000 [8]山东第一医科大学附属省立医院小儿重症医学科,济南250000 [9]南京医科大学附属南京儿童医院急诊/重症医学科,南京210000 [10]济南儿童医院重症医学科,济南250000 [11]聊城市人民医院儿童重症监护室,聊城252000

出　　处：《中华儿科杂志》2022年第3期197-202,共6页Chinese Journal of Pediatrics

摘　　要：目的了解我国部分儿童重症监护病房(PICU)内先天性心脏病(简称先心病)患儿心肺骤停后实施心肺复苏的效果及预后影响因素。方法回顾性分析2017年11月至2018年10月我国11家医院PICU收治的281例心肺骤停且接受标准心肺复苏的患儿资料,根据是否患有先心病分为先心病组和非先心病组,比较一般情况、心肺复苏持续时间、复苏过程中肾上腺素使用次数、自主循环恢复(ROSC)率、出院存活率、出院儿童脑功能分类量表等临床资料。根据是否以恶性心律失常为心肺骤停直接原因分为心律失常和非心律失常2个亚组,比较患儿ROSC和出院存活率。组间比较采用t检验、χ^(2)检验或方差分析,采用Logistic回归分析先心病心肺骤停患儿ROSC和出院存活的影响因素。结果我国部分PICU内心肺骤停发生率为3.2%(372/11588),心肺复苏实施率为75.5%(281/372)。281例发生心肺骤停并接受心肺复苏的患儿中男144例,女137例,年龄32.8(5.6,42.7)月龄。先心病组患儿56例(19.9%),非先心病组患儿225例(80.1%)。先心病组女性患儿占比高于非先心病组[60.7%(34/56)比45.8%(103/225),χ^(2)=4.00,P=0.045]。先心病组和非先心病组ROSC率和出院存活率差异均无统计学意义(均P>0.05)。先心病组心律失常组患儿的ROSC率高于非心律失常组[70.0%(28/40)比6/16,χ^(2)=5.06,P=0.024]。出院时先心病组和非先心病组儿童脑功能分类量表评分达到良好(1~3分)的比例分别为50.9%(26/51)和44.9%(92/205)。Logistic回归分析提示先心病患儿ROSC和出院存活的独立影响因素均为心肺复苏持续时间[比值比(OR)=0.95、0.97;95%CI:0.92~0.97,0.95~0.99;均P<0.05]和肾上腺素使用次数[OR=0.87、0.79,95%CI:0.76~1.00、0.69~0.89,均P<0.05]。结论先心病心肺骤停患儿复苏成功率与非先心病患儿相似。肾上腺素使用次数、心肺复苏持续时间是先心病患儿ROSC率和出院存活率的影响因素。Objective To investigate the prognostic factors of children with congenital heart disease(CHD)who had undergone cardiopulmonary resuscitation(CPR)in pediatric intensive care unit(PICU)in China.Methods From November 2017 to October 2018,this retrospective multi-center study was conducted in 11 hospitals in China.It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group.The general condition,duration of CPR,epinephrine doses during resuscitation,recovery of spontaneous circulation(ROSC),discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared.According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not,children in CHD and non-CHD groups were divided into 2 subgroups:arrhythmia and non-arrhythmia,and the ROSC and survival rate to discharge were compared.Data in both groups were analyzed by t-test,chi-square analysis or ANOVA,and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest(CA).Results The incidence of CA in PICU was 3.2%(372/11588),and the implementation rate of CPR was 75.5%(281/372).There were 144 males and 137 females with median age of 32.8(5.6,42.7)months in all 281 CPA cases who received CPR.CHD group had 56 cases while non-CHD had 225 cases,with the percentage of 19.9%(56/281)and 80.1%(225/281)respectively.The proportion of female in CHD group was 60.7%(34/56)which was higher than that in non-CHD group(45.8%,103/225)(χ^(2)=4.00,P=0.045).There were no differences in ROSC and rate of survival to discharge between the two groups(P>0.05).The ROSC rate of children with arthythmid in CHD group was 70.0%(28/40),higher than 6/16 for non-arrhythmic children(χ^(2)=5.06,P=0.024).At discharge,the pediatric cerebral performance category scores(1-3 scores)of CHD and non-CHD child were 50.9%(26/51)and 44.9%(92/205)respectively.Logistic regression analysis indicated that the independent prognos

关 键 词：心脏停搏 心肺复苏术 心脏缺损 先天性 重症监护病房 儿科 

分 类 号：R725.4[医药卫生—儿科]