急诊成人体外心肺复苏患者出院存活相关因素分析  

Analysis of factors associated with survival to hospital discharge in emergency adult extracorporeal cardiopulmonary resuscitation patients

作　　者：陈鹏远 姚晓月 杨旻斐[1] 周光居[2] 魏金涛 郑成 黄权能 徐嘉妮 钱珂 Chen Pengyuan;Yao Xiaoyue;Yang Minfei;Zhou Guangju;Wei Jintao;Zheng Cheng;Huang Quanneng;Xu Jiani;Qian Ke(Department of Nursing,The Second Afffliated Hospital of Zhejiang University School of Medicine,Hang Zhou 310009,China;Department of Emergency Medicine,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hang Zhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院护理部,杭州310009 [2]浙江大学医学院附属第二医院急诊医学科,杭州310009

出　　处：《中华急诊医学杂志》2024年第12期1738-1742,共5页Chinese Journal of Emergency Medicine

基　　金：浙江省重点研发计划项目(2021C03036)。

摘　　要：目的总结体外心肺复苏患者的临床特点并分析其出院存活相关因素。方法回顾性分析浙江大学医学院附属第二医院急诊中心2020年1月至2023年12月共54例体外心肺复苏患者数据,根据其出院30 d内存活状态,分为出院存活组与死亡组。采用Kaplan Meier法绘制生存曲线,应用COX回归分析法分析影响出院存活的相关因素。结果(1)本次研究共纳入54例体外心肺复苏患者,出院存活17例(31.5%),其中神经功能预后良好患者为10例(58.8%),死亡37例(68.5%);(2)Kaplan-Meier生存分析结果显示,第一目击者行CPR、建立下肢灌注管、行主动脉内球囊反搏(intra-aortic balloon pump,IABP)、恢复ROSC、pH指标正常及初始瞳孔大小存在对光反射的患者中位生存时间更长(P<0.05);(3)单因素COX回归分析显示,不同ECMO机器维持时间、低灌注时间、初始瞳孔大小、APACHEⅡ评分的患者生存时间差异有统计学意义(P<0.05);(4)多因素COX回归分析显示APACHEⅡ评分、初始瞳孔及IABP是急诊ECPR患者出院存活的独立影响因素;(5)模型一致性指数为0.921。结论该生存模型具有较好的预测准确性,医护人员可以利用APACHEⅡ评分及入院初始瞳孔大小,作为辅助判断患者预后的重要参考指标,结合病情及时开展IABP治疗,以提高患者出院存活率。Objective To summarize the clinical features of out-of-hospital extracorporeal cardiopulmonary resuscitation(ECPR)patients and analyze the factors associated with discharge survival.Methods The data of 54 patients with ECPR in the Emergency Center of the Second Hospital Afffliated to Zhejiang University School of Medicine from January 2020 to December 2023 were analyzed.Patients were divided into the survival group and death group based on their survival status within 30 days of discharge.Kaplan Meier method was used to draw the survival curve,and COX regression analysis was used to analyze the relevant factors of survival.Results(1)A total of 54 patients with ECPR were included in this study.17(31.5%)cases were discharged alive,of which 10(58.8%)had a good neurological prognosis,while 37 case(68.5%)died.(2)Kaplan-Meier survival analysis showed that patients who received ffrst-witness CPR, had a lower-extremity perfusion line established, underwent IABP, achieved ROSC, had normal pH, and had an initial pupillary light reffex had a longer median survival time (P < 0.05).(3)Univariate COX regression analysis showed that statistically differences in survival time among patients with ECMO times, hypoperfusion times, initial pupil sizes, and APACHE Ⅱ scores ( P < 0.05);(4)Multivariate COX regression analysis showed that APACHE Ⅱ score, initial pupil size, and IABP were independent predictors of survival of patients discharged from the hospital with emergency ECPR;(5)The concordance index of the COX regression model was 0.921. Conclusions The survival model demonstrates good predictive accuracy. Healthcare professionals can use the APACHE Ⅱ score and initial pupil size on admission as important reference indicators to assist in determining patient prognosis, and to timely initiate IABP treatment, in conjunction with the patient’s condition, to improve the survival rate of patients discharged from the hospital.

关 键 词：心脏骤停体外心肺复苏 急诊 存活 主动脉内球囊反搏 

分 类 号：R459.7[医药卫生—急诊医学]