影响呼吸心跳骤停患者心肺复苏机治疗效果的因素分析及预防对策  

Influencing Factors of Cardiopulmonary Resuscitation Machine in Patients with Respiratory and Cardiac Arrest and Preventive Measures

作　　者：邓炜伦 尹江宁 彭易根 纪美玲 袁欣怡 DENG Weilun;YIN Jiangning;PENG Yigen;JI Meiling;YUAN Xinyi(Department of Emergency,Nanjing Jiangning Hospital,Nanjing 211100,China;Grade 2021 Clinical Medicine,Jiangsu University,Zhenjiang,Jiangsu 212000,China)

机构地区：[1]江苏省南京江宁医院急诊科,江苏南京211100 [2]江苏大学,江苏镇江212000

出　　处：《转化医学杂志》2024年第5期681-685,共5页Translational Medicine Journal

基　　金：北京协和医学基金会睿意急诊医学研究基金资助(编号:22322012010)。

摘　　要：目的探究呼吸心跳骤停患者使用心肺复苏机进行心肺复苏(CPR)治疗疗效的影响因素,并探讨预防对策。方法回顾性选取江苏省南京江宁医院急诊科2021年6月至2024年3月急诊抢救的98例呼吸心跳骤停患者,均行心肺复苏机CPR。收集其临床相关资料,观察复苏结果,将其分为自主循环恢复(ROSC)组和非ROSC组。比较2组患者临床资料,进行单因素和多因素逐步Logistic回归分析,确定影响患者疗效的独立因素。结果本研究98例患者中行心肺复苏机CPR治疗后ROSC率为37.76%(37/98)。ROSC组年龄≥65岁占比、开始CPR时间>4 min占比、心源性病因占比、使用肾上腺素累积量>5 mg占比、气管插管时间>180 s占比均低于非ROSC组,电击除颤占比高于非ROSC组(P<0.05)。多因素逐步Logistic回归结果显示,开始CPR时间(OR=5.226,95%CI:2.307~11.834)、使用肾上腺素累积量(OR=3.814,95%CI:1.318~11.034)、气管插管时间(OR=3.427,95%CI:1.611~7.288)是影响患者ROSC的独立危险因素,电击除颤(OR=0.211,95%CI:0.085~0.523)是独立保护因素(P<0.05)。结论开始CPR时间、使用肾上腺素累积量、气管插管时间是影响心肺复苏机CPR治疗的呼吸心跳骤停患者ROSC的独立危险因素,电击除颤是独立保护因素。临床通过早期采取合理措施可有效提升抢救成功率,改善预后。Objective To explore the factors influencing the effectiveness of cardiopulmonary resuscitation(CPR)treatment in patients with respiratory and cardiac arrest using a CPR machine,and to analyze preventive countermeasures to improve rescue success rates and patient prognosis.Methods A total of 98 patients with respiratory and cardiac arrest rescued in the emergency department of Jiangning Hospital,Jiangsu Province,from June 2021 to March 2024 were retrospectively selected.Their clinical data were collected,and the resuscitation outcomes were observed.Patients were divided into the return of spontaneous circulation(ROSC)group and the non-ROSC group.The clinical data of the two groups were compared,and univariate and multivariate stepwise Logistic regression analyses were conducted to identify independent factors affecting the treatment efficacy..Results The ROSC rate after mechanically assisted CPR was 37.76%(37/98).Compared with the non-ROSC group,the ROSC group had significantly lower proportions of patients aged≥65 years,time to start CPR>4 min,cardiac causes,cumulative epinephrine dose>5mg,and tracheal intubation time>180 s,while the proportion of patients with shock defibrillation was significantly higher(P<0.05).Multivariate stepwise Logistic regression analysis revealed that delayed initiation of CPR(OR=5.226,95%CI:2.307-11.834),cumulative epinephrine use(OR=3.814,95%CI:1.318-11.034),and prolonged intubation time(OR=3.427,95%CI:1.611-7.288)were independent risk factors for ROSC.Shock defibrillation(OR=0.211,95%CI:0.085-0.523)was an independent protective factor(P<0.05).Conclusion Delayed CPR initiation,high cumulative epinephrine dose,and prolonged intubation time are independent risk factors for ROSC,while shock defibrillation serves as an independent protective factor.Early and reasonable measures can effectively enhance rescue success rates and improve patient outcomes.

关 键 词：呼吸心跳骤停 心肺复苏 自主循环恢复 影响因素 预防对策 

分 类 号：R459.7[医药卫生—急诊医学] R654.1[医药卫生—治疗学]