院外猝死的特征和复苏效应——一项基于互联网数据的研究  

Characteristics and resuscitation effects of out-of-hospital sudden death:a study based on Internet data

作　　者：孙梦雪 赵嘉艺 朱爱群[1] Sun Mengxue;Zhao Jiayi;Zhu Aiqun(Clinical Nursing Teaching and Research Section,the Second Xiangya Hospital of Central South University,Changsha 410011,Hunan,China)

机构地区：[1]中南大学湘雅二医院临床护理学教研室,湖南长沙410011

出　　处：《中华危重病急救医学》2023年第8期844-848,共5页Chinese Critical Care Medicine

基　　金：湖南省卫生健康委员会科研项目 (202214052730)。

摘　　要：目的:收集互联网有关"猝死"的新闻报道,分析猝死患者的特征和复苏效果,为制定干预策略提供借鉴。方法:应用互联网,在"百度"和"360搜索"网站,以"猝死"和"心脏骤停"为关键词进行搜索,收集猝死事件报道时间限定为2013年1月至2022年12月,记录并分析猝死患者的年龄、性别、猝死发作特征、心肺复苏(CPR)实施特点及院前和最终临床结局等。分别对院前及最终临床结局进行亚组分析;采用非条件多因素Logistic回归分析筛选影响猝死患者院前及最终临床结局的相关因素。结果:最终确定了177篇新闻报道,涉及猝死患者177例,其中男性152例(占85.9%),女性25例(占14.1%);年龄(37.27±16.82)岁,其中16~45岁占53.1%;触发因素主要包括剧烈运动(29.9%)、心脏病史(7.9%)、过度劳累(6.2%)、熬夜失眠(4.0%)、情绪激动(2.8%)等,有48.0%的患者无明显诱因。经现场急救,有104例(58.8%)患者院前实现自主循环恢复(ROSC),其中18例(10.2%)恢复意识;入院后经临床治疗,最终109例(61.6%)实现ROSC,其中86例(48.6%)恢复意识,有22例(12.4%)未报道最终结局。亚组分析显示,与院前实现ROSC患者( n=104)比较,非ROSC患者( n=73)猝死发生在睡眠中和居住地的比例更高,且未立即实施CPR、未全程实施CPR或未使用自动体外除颤器(AED)除颤的比例更高;最终临床未恢复意识患者( n=91)与恢复意识患者( n=86)相比,也表现出相似的特征。多因素Logistic回归分析显示,立即CPR 〔院前ROSC:优势比( OR)=8.06,95%可信区间(95% CI)为2.36~27.46;最终恢复意识: OR=9.10,95% CI为2.46~33.68〕和AED除颤(院前ROSC: OR=36.31,95% CI为4.53~291.19;最终恢复意识: OR=3.53,95% CI为1.45~8.61)均有利于猝死患者院前实现ROSC并最终意识恢复。 结论:院外猝死主要发生在年轻群体,剧烈运动是院外猝死的潜在因素之一,近一半猝死患者无明显诱因。立即快速CPR和AED除颤是最简单有效的现场急救方法,加强Objective To collect the Internet news about"sudden death",analyze its characteristics and resuscitation effects,so as to provide reference for formulating intervention strategies.Methods The Internet was used to search for"sudden death"and"cardiac arrest"on"Baidu"and"360"websites.Reports of sudden death events were collected from January 2013 to December 2022.The age,gender,characteristics of sudden death,implementation characteristics of cardiopulmonary resuscitation(CPR),and pre-hospital and final clinical outcomes of sudden death patients were recorded and analyzed.Subgroup analyses were performed for pre-hospital and final clinical outcomes.Unconditional multivariate Logistic regression analysis was used to screen the related factors affecting the pre-hospital and final clinical outcomes in patients with sudden death.Results 177 news reports were finally confirmed,involving 177 sudden death patients,including 152 males(85.9%)and 25 females(14.1%),aged(37.27±16.82)years old,and 53.1%in the 16-45 years old group.Triggering factors included strenuous exercise(29.9%),heart disease history(7.9%),overwork(6.2%),staying up late and insomnia(4.0%),activation of emotion(2.8%),and no obvious inducement(48.0%).After on-site first aid,104 cases(58.8%)achieved restoration of spontaneous circulation(ROSC)before hospital admission,and 18 cases(10.2%)recovered consciousness.After clinical treatment,109 cases(61.6%)achieved ROSC,86 cases(48.6%)recovered consciousness,and 22 cases(12.4%)did not report the final outcome.Subgroup analysis showed that compared with patients who achieved pre-hospital ROSC(n=104),sudden death in non-ROSC patients(n=73)mainly occurred during sleep,in residence and without immediate CPR,full CPR,or automated external defibrillator(AED);and patients who ultimately did not recover consciousness clinically(n=91)showed similar characteristics compared with patients who recovered consciousness(n=86).Multifactorial Logistic regression analysis showed that immediate CPR[pre-hospital ROSC:odds ratio(OR)=8.

关 键 词：院外猝死 互联网数据 心肺复苏 相关因素 

分 类 号：R541.78[医药卫生—心血管疾病]