ACS患者心肺复苏结局影响因素的回顾性研究  

Retrospective study on the influencing factors of cardiopulmonary resuscitation outcomes in ACS patients

作　　者：苏晨[1] 吴海东[1] 王彤[1] SU Chen;WU Haidong;WANG Tong(Department of Emergency,the Eighth Affiliated Hospital of Sun Yat-sen University,Guangzhou,518033,China)

机构地区：[1]中山大学附属第八医院急诊科,广州518033

出　　处：《临床急诊杂志》2024年第11期592-596,603,共6页Journal of Clinical Emergency

摘　　要：目的:探讨因急性冠脉综合征(acute coronary syndrome,ACS)诱发心搏骤停(cardiopulmonary arrest,CA)患者心肺复苏后,住院期间死亡的危险因素。方法:纳入62例2019年9月—2024年7月于中山大学附属第八医院(深圳福田)心肺复苏术后并收治入院的CA患者。所有患者病因均经冠脉造影检查确诊为ACS。根据住院期间是否死亡分为死亡组与好转出院组(对照组)。对比各组的临床资料,并以Gensini评分作为反映患者冠脉狭窄程度的指标,分析影响患者住院期间死亡率的因素。结果:复苏前心律(OR=10.78,95%CI:1.16~100.37)、年龄(OR=1.08,95%CI:1.01~1.16)、Gensini评分(OR=1.06,95%CI:1.01~1.11)、高血钾(OR=9.53,95%CI:1.73~52.54)是患者住院期间死亡的独立危险因素。在ROC曲线分析中,联合复苏前心律、年龄、Gensini评分和血钾水平构建预测因子的曲线下面积为0.958。结论:复苏前心律、年龄、Gensini评分和血钾水平是ACS患者CA并成功接受心肺复苏术后,住院期间死亡的独立危险因素。联合四项指标可以对患者住院期间死亡起到较好的预测作用。Objective:To investigate the risk factors associated with in-hospital mortality in patients suffering from cardiopulmonary arrest(CA) due to acute coronary syndrome(ACS) who have undergone successful cardiopulmonary resuscitation(CPR).Methods:We enrolled 62 patients who experienced CA and received successful CPR at the Eighth Affiliated Hospital of Sun Yat-sen University(Futian,Shenzhen) between September 2019 and July 2024.The diagnosis of ACS was confirmed by coronary angiography for all patients.Based on their in-hospital survival status,patients were categorized into either the mortality group or the recovery and discharge group(control group).Clinical data were compared between the two groups,and the Gensini score was utilized to assess the severity of coronary stenosis.Factors influencing in-hospital mortality were analyzed.Results:The independent risk factors for in-hospital mortality were identified as pre-resuscitation cardiac rhythm(OR=10.78,95%CI:1.16-100.37),age(OR=1.08,95%CI:1.01-1.16),Gensini score(OR=1.06,95%CI:1.01-1.11),and hyperkalemia(OR=9.53,95%CI:1.73-52.54).In the ROC curve analysis,a predictive model combining pre-resuscitation cardiac rhythm,age,Gensini score,and serum potassium level yielded an area under the curve of 0.958.Conclusion:Pre-resuscitation cardiac rhythm,age,Gensini score,and serum potassium level are independent predictors of in-hospital mortality in patients with ACS who have undergone successful CPR following CA.The combination of these four indicators serves as a reliable tool for predicting in-hospital mortality in this patient population.

关 键 词：急性冠脉综合征 心搏骤停 心肺复苏 GENSINI评分 

分 类 号：R541.7[医药卫生—心血管疾病]