院外心脏骤停患者心肺复苏影响因素分析及其对策  

Influence factors and countermeasures of cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients

作　　者：胡磊 任菁菁[1] 邱艳[1] HU Lei;REN Jingjing;QIU Yan(Department of General Practice,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,Zhejiang 310003,China;不详)

机构地区：[1]浙江大学医学院附属第一医院全科医学科,浙江杭州310003 [2]杭州市临安区第一人民医院急诊科,浙江杭州311399

出　　处：《中华全科医学》2024年第5期759-763,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2024KY1456)。

摘　　要：目的分析院外心脏骤停(OHCA)患者的临床特征和影响心肺复苏(CPR)成功的因素,探讨目前救治存在的问题并提出合理有效的改进对策。方法选择2019年1月1日—2022年12月31日期间杭州市临安区第一人民医院急诊救治的229例OHCA并行CPR的患者为研究对象,根据复苏结果分为复苏成功组(71例)和复苏失败组(158例)。采用Utstein模式回顾性分析影响OHCA患者复苏成功(ROSC)的相关因素,通过与现阶段国内研究数据对比,寻找目前我区救治存在的问题并提出合理有效的解决办法。结果单因素分析显示,影响OHCA患者ROSC的因素为院前急救反应时间、有无第一目击者、有无即刻CPR、有无6 min内CPR、有无院前急救、首次监测心律类型、电除颤次数、电除颤时间、CPR总时长(P<0.05)。多因素logistic回归分析显示,院前急救反应时间(P=0.020)、有无6 min内CPR(P=0.002)为OHCA患者ROSC的独立影响因素。院前急救反应时间每增加一个单位,复苏成功率降低约27.3%(95%CI:0.557~0.950),有6 min内CPR者复苏成功率较无6 min内CPR者增高约8.8倍(95%CI:2.226~34.804)。结论缩短院前急救反应时间、心脏骤停发生后尽早进行高质量CPR能够有效提高OHCA患者ROSC成功率。Objective To analyze the clinical characteristics of patients with out-of-hospital cardiac arrest(OHCA)and identify the factors affecting the success of cardiopulmonary resuscitation(CPR).Additionally,explore the current treatment problems and propose rational and effective improvement strategies.Methods A total of 229 patients with OHCA and concurrent CPR,who received emergency treatment at the First People's Hospital of Lin'an District,Hangzhou City from January 1,2019 to December 31,2022,were selected as the research subjects.According to the resuscitation outcomes,they were categorized into a successful resuscitation group(71 cases)and a failed resuscitation group(158 cases).The Utstein model was used to retrospectively analyze the relevant factors affecting the success of OHCA patient resuscitation.By comparing it with current domestic research data,we aim to identify the existing problems in treatment and propose reasonable and effective solutions.Results Univariate analysis showed that several risk factors affecting the success rate of return of spontaneous circulation(ROSC)in OHCA patients.These factors included the pre-hospital emergency response time,presence or absence of witnesses,immediate CPR,presence or absence of CPR within 6 minutes,presence or absence of pre-hospital emergency,type of first monitored heart rhythm,frequency of defibrillation,duration of defibrillation,and total duration of CPR(P<0.05).Multivariate logistic regression analysis showed that both pre-hospital emergency response time(P=0.020)and the presence or absence of CPR within 6 minutes(P=0.002)were independent risk factors for successful resuscitation in OHCA patients.Specifically,an increase in pre-hospital emergency response time was associated with a decrease in the success rate of resuscitation by approximately 27.3%per unit increase(95%CI:0.557-0.950).Individuals who received CPR within 6 minutes had a significantly higher success rate compared to those without timely intervention,approximately 8.8 times higher odds for su

关 键 词：院外心脏骤停 心肺复苏 院前急救反应时间 第一目击者 培训 

分 类 号：R541.78[医药卫生—心血管疾病] R605.974[医药卫生—内科学]