杭州地区创伤性心脏骤停患者院前急救流行病学分析  

Epidemiological analysis of pre-hospital emergency treatment for traumatic cardiac arrest patients in Hangzhou

作　　者：钱里娜[1] 宋因力[2] 张军根[3] 陈晓玲 QIAN Lina;SONG Yinli;ZHANG Jungen(Department of Quality Control,Hangzhou Emergency Medical Center of Zhejiang Province,Hangzhou 310021,China)

机构地区：[1]浙江省杭州市急救中心质控科,浙江杭州310021 [2]浙江省杭州市急救中心科教培训科,浙江杭州310021 [3]浙江省杭州市急救中心党政综合办公室,浙江杭州310021

出　　处：《全科医学临床与教育》2024年第3期200-203,223,共5页Clinical Education of General Practice

基　　金：杭州市科技局引导项目(20211231Y073);杭州市科技局引导项目(20220919Y065);浙江省卫生健康委面上项目(2021440029)。

摘　　要：目的分析2022年杭州院前创伤性心脏骤停(TCA)事件的流行病学特征。方法采用回顾性研究方法,采集2022年度杭州地区院外心脏骤停(OHCA)事件2737例,从中筛选TCA事件共298例,收集298例TCA患者年龄、性别、发生地、受伤类型、被目击情况、目击者施救、初始心律、院外除颤、院外气管插管、院外使用肾上腺素、急救反应时间等数据,并分析其对TCA患者预后的影响。结果298例TCA患者中位数年龄为49(31,61)岁,性别以男性为主,占66.78%;TCA事件多发生在公共场所,坠落伤多见,占56.04%;TCA事件多发生在5∶00~19∶59,尤其以5∶00~9∶59最多;TCA事件在四个季度均有发生,第二、三季度发病率相对较高,合计占比56.38%。298例TCA患者有复苏指征的共计145例(48.65%),仅7例(4.83%)患者院前自主循环恢复(ROSC)成功。目击者施救、钝性伤、患者初始心律为可除颤心律、院外除颤、院外气管插管、院外使用肾上腺素治疗、急救反应时间≤10 min对TCA患者ROSC成功有积极影响(χ^(2)分别=6.34、4.62、18.27、11.07、11.54、7.20、5.75,P均<0.05),患者年龄和调度员是否进行电话医学指导对TCA患者ROSC成功无影响(χ^(2)分别=0.07、0.42,P均>0.05)。结论TCA患者发病年龄小,以男性为主,发生场所多在公共场所,目前的复苏存活率存在较大改善空间,改善院外生存链的一系列因素如目击者基础生命支持的有效实施、院外及时除颤,积极进行高级心肺复苏,缩短急救反应时间有助于增加TCA患者的ROSC成功比例。Objective To analyze the epidemiological characteristics of pre-hospital traumatic cardiac arrest(TCA)in Hangzhou in 2022.Methods A retrospective study method was employed,collecting data from 2,737 out-of-hospi⁃tal cardiac arrest(OHCA)events in Hangzhou city in 2022.Among these,298 cases of TCA were selected,gathering in⁃formation on patient age,gender,location of occurrence,injury type,witnessed status,bystander CPR,initial rhythm,prehospital defibrillation,pre-hospital endotracheal intubation,pre-hospital adrenaline administration,emergency response time,etc.The data were analyzed to assess their impact on the prognosis of TCA patients.Results The median age of 298 TCA patients was 49(31,61)years old,and the gender was mainly male,accounting for 66.78%.TCA events oc⁃curred in public places,and falling injuries accounted for 56.04%.TCA events mostly occurred from 5∶00 to 19∶59,especially from 5∶00 to 9∶59.TCA events occurred in four quarters,with relatively high incidence rate in the second and third quarters,accounting for 56.38%.A total of 145(48.65%)of 298 TCA patients had indications for resuscitation,and only 7(4.83%)patients had successful ROSC.Wit⁃ness rescue,blunt injury,initial heart rhythm was defibrillation,defibrillation,out-hospital endotrache⁃al intubation,out-hospital adrenaline,emergency re⁃sponse time less than or equal to 10 minutes had positive effects on successful ROSC in TCA patients(χ^(2)=6.34,4.62,18.27,11.07,11.57,11.54,7.20,5.75,P<0.05),patient's age and medical guidance by telephone had no effect on successful ROSC in TCA patients(χ^(2)=0.07,0.42,P>0.05).Conclusion TCA patients tend to be younger males with incidents commonly occurring in public settings.There is considerable room for improvement in current resuscitation survival rates.Enhancing various factors in the pre-hospital survival chain,such as effective implementation of bystander basic life support,timely pre-hospital defibrillation,active advanced life support,and reducing emergency response times,con

关 键 词：创伤心脏骤停 院外心脏骤停 流行病学 自主循环恢复 

分 类 号：R459.7[医药卫生—急诊医学] R181.3[医药卫生—治疗学]