院外心搏骤停的流行病学特点分析  

Epidemiological observation and multivariate analysis of out-of-hospital cardiac arrest

作　　者：孟宇 张春艳[2] 安慧茹[3] 梁建琴[3] 池菲[2] 李香兰[2] Meng Yu;Zhang Chunyan;An Huiru;Liang Jianqin;Chi Fei;Li Xianglan(Shijiazhuang Emergency Center,Hebei Shijiazhuang 050021,China;Department of Emergency,Hebei Chest Hospital,Hebei Shijiazhuang 050047,China;Eighth Medical Center of Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]石家庄市急救中心,河北石家庄050021 [2]河北省胸科医院急诊科,河北石家庄050047 [3]解放军总医院第八医学中心,北京100091

出　　处：《中国医刊》2022年第6期650-653,共4页Chinese Journal of Medicine

基　　金：2019年度河北省医学科学研究重点课题(20191017)。

摘　　要：目的探究院外心搏骤停的流行病学现状及其结局影响因素。方法收集2018年2月至2019年1月石家庄市急救中心接诊的3127例院外心搏骤停患者的临床资料,分析其病因、发生地点、气道建立方式、胸外按压方式、心电监护、除颤次数、急诊绿色通道是否畅通、复苏结果、有无目击者、目击者进行心脏复苏救治等情况,分析心搏骤停后自主循环恢复的影响因素。结果院外心搏骤停51.90%发生在家中,其次为工作地点(32.71%)、公共场所(13.46%)。有59.51%的患者被目击,但仅4.45%的患者由目击者进行心脏复苏救治,19.87%的患者院外进行气管插管,51.93%的患者院外进行肾上腺素治疗。临床病因分析发现,院外心搏骤停的原因以心源性疾病最多(46.02%),其次分别为创伤性(31.53%)、其他(10.97%)、溺水(7.39%)、呼吸系统疾病(4.09%)。自主循环恢复的例数有目击者(52例)、目击者进行心脏复苏救治(64例)、初始心律可电击(43例)、急救反应时间≤6min(48例)、院外除颤(45例)分别高于无目击者(25例)、目击者未进行心脏复苏救治(13例)、初始心律不可电击(34例)、急救反应时间>6min(29例)、院外未除颤(32例),差异有显著性(P<0.05)。Logistic回归分析显示,有目击者、目击者进行心脏复苏救治、初始心律可电击、急救反应时间≤6min、院外除颤是院外心搏骤停患者自主循环恢复的独立影响因素。结论院外心搏骤停患者大部分发生在家中,其次为工作地点、公共场所,有目击者、目击者进行心脏复苏救治、初始心律可电击、急救反应时间≤6min、院外除颤是其自主循环恢复的独立影响因素。Objective To investigate the epidemiological observation and multivariate analysis of out-of-hospital cardiac arrest.Method The clinical data of 3127 out-of-hospital cardiac arrest patients admitted to the Shijiazhuang Emergency Center from February 2018 to January 2019 were collected,and the etiology,location,time,airway establishment,chest compression,ECG monitoring,defibrillation times,whether the emergency green channel is unobstructed,resuscitation results,presence or absence of witnesses,and cardiac resuscitation by witnesses,etc.,and analyze the factors for the recovery of spontaneous circulation after cardiac arrest.Result 51.90% of out-of-hospital cardiac arrest patients occurred at home,followed by workplaces(32.71%)and public places(13.46%).59.51% of the patients were witnessed,but only 4.45% of the patients were treated with cardiac resuscitation by witnesses,19.87% of the patients were treated with tracheal intubation outside the hospital,and 51.93% of the patients were treated with epinephrine outside the hospital.According to the analysis of clinical etiology,out-of-hospital cardiac arrest patients had the most cardiac diseases(46.02%),followed by trauma(31.53%),other(10.97%),drowning(7.39%),and respiratory system diseases(4.09%).Among the cases with recovery of spontaneous circulation,there were witnesses,witnesses performed cardiac resuscitation,shockable initial heart rhythm,short emergency response time,and patients who could be defibrillated outside the hospital the number of spontaneous circulation recovery cases was higher than that of no witnesses,witnesses without CPR,initial heart rhythm not shockable,longer emergency response time,Out-of-hospital patients who could not defibrillate,the difference was significant(P<0.05).Logistic regression analysis showed that the presence or absence of witnesses,cardiac resuscitation performed by witnesses,initial heart rhythm,emergency response time,and out-of-hospital defibrillation were the influencing factors for the recovery of spontaneous circulat

关 键 词：心搏骤停 心脏复苏 初始心律 急救 除颤 

分 类 号：R459.7[医药卫生—急诊医学]