初始复苏时不同通气方式对院内心脏骤停患者短期预后的影响  

The impact of different ventilation modalities during initial resuscitation on short-term outcomes in patients with in-hospital cardiac arrest

作　　者：陈植炜 官运杰 张舒娇 吕慧洪 林志鸿[1,2] Chen Zhiwei;Guan Yunjie;Zhang Shujiao;Lyu Huihong;Lin Zhihong(Department of Emergency,the First Affiliated Hospital,Fujian Medical University,Fuzhou 350004,China;Department of Emergency,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou 350212,China)

机构地区：[1]福建医科大学附属第一医院急诊医学中心,福州350004 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心急诊医学中心,福州350212

出　　处：《中华急诊医学杂志》2025年第3期382-388,共7页Chinese Journal of Emergency Medicine

基　　金：福建省科技厅引导性项目(2021Y0014)。

摘　　要：目的 为研究初始复苏时不同通气方式对成人院内心脏骤停(in-hospitalcardiac arrest,IHCA)患者短期预后的影响。方法 回顾性纳人福建医科大学附属第一医院2019年9月至2021年12月所有住院及人住急诊抢救室、观察室且年龄≥18岁成人患者,记录期间所有发生IHCA且复苏期间均接受气道管理的患者的一般资料、基础疾病及短期预后等指标。根据复苏时接受的通气方式分为非高级气道组和高级气道组。主要结局为自主循环恢复(return of spontaneous circulation,ROSC)≥20min,次要结局为出院存活及出院存活良好神经功能。Logistic回归分析不同通气方式对成人IHCA患者短期预后的影响,并构建成人IHCA患者ROSC的预测模型,用受试者工作特征曲线下面积(area under the curve,AUC)评估模型的预测效能。结果 最终纳人285例成人IHCA患者。其中非高级气道组75例,高级气道组210例。所有患者中,ROSC≥20 min的127例,出院存活51例,出院存活良好神经功能35例。Logistic回归分析显示通气方式、肾上腺素使用剂量,骤停地点是影响成人IHCA患者ROSC的独立危险因素;与非高级气道相比,高级气道管理与ROSC率更高相关(OR=3.698,95%CI:1.844~7.419,P<0.001),但不同通气方式对成人IHCA患者出院存活(OR=1.097,95%CI:0.506~2.376,P=0.815)及出院存活良好神经功能(OR=0.548,95%CI:0.224~1.339,P=0.187)的影响差异无统计学意义。将通气方式、肾上腺素使用剂量,骤停地点作为预测变量代人多因素Logistic回归模型中构建成人IHCA患者ROSC的预测模型,绘制受试者操作特性(receiveroperating characteristic,ROC)曲线,得出模型AUC值0.735(0.678~0.793)。亚组分析显示,早期高级气道管理能提高非心源性心脏骤停患者ROSC率,但不能改善心源性心脏骤停患者ROSC率,且与患者更低的出院存活及更差的出院存活神经功能相关。结论 与非高级气道相比,复苏时高级气道管理可提高成人Objective To investigate the impact of different ventilation modalities during initial resuscitation on short-term outcomes in adult patients with in-hospital cardiac arrest(IHCA).Methods7This retrospective study included adult patients(age≥18 years)admitted to the emergency resuscitation or observation units of our hospital from September 2019 to December 2021.Demographic data,comorbidities,and short-term outcomes of IHCA patients who underwent airway management during resuscitation were recorded.Participants were stratified into non-advanced airway and advanced airway groups based on ventilation modality.The primary outcome was defined as sustained return of spontaneous circulation(ROSC)≥20 min,and secondary outcomes included survival to discharge and favorable neurological status at discharge.Logistic regression analyses were performed to assess the impact of different ventilation modalities on short-term outcomes among adult IHCA patients.and developed a prediction model of ROSC for adult IHCA patients,and its predictive performance was evaluated by the area under the curve(AUC)of the receiver operating characteristic.Results Among 285 IHCA patients(non-advanced airway:n=75;advanced airway:n=210),127 achieved ROSC≥20 min,51 survived to discharge,and 35 had favorable neurological outcomes.Logistic regression identified ventilation modality,epinephrine dose,and arrest location as independent predictors of ROSC in adult IHCA patients.Advanced airway management demonstrated significantly higher ROSC rates compared to non-advanced interventions(OR=3.698,95%CI:1.844-7.419,P<0.001).However,no significant associations were observed between ventilation modalities and survival to discharge(OR=1.097,95%CI:0.506-2.376,P=0.815)or favorable neurological outcomes at discharge(OR=0.548,95%CI:0.224-1.339,P=0.187).Ventilation modality,epinephrine dose,and arrest location were incorporated as predictors in a multivariable logistic regression model to develop a ROSC prediction model for adult IHCA patients.The discriminati

关 键 词：险院内心脏骤停 心肺复苏 气道管理 气管插管 预测模型 

分 类 号：R47[医药卫生—护理学]