摘要
目的分析急诊科心肺复苏(CPR)患者的临床资料、特征及影响复苏成功的因素,合理调配医疗资源,改进CPR流程,提高CPR成功率。方法选择2009年12月至2019年12月在天津市第三中心医院急诊科Utstein注册登记的538例心搏骤停患者为研究对象,分析临床资料及特征,依据是否复苏成功将患者分为复苏成功组和复苏失败组,分析影响复苏成功的因素。结果共纳入538例患者,平均年龄(65.53±15.56)岁,其中71~80岁年龄段患者数最多(145例,占27.0%),其次为61~70岁(105例,占19.5%)和51~60岁(99例,占18.4%)。心搏骤停的原因主要为急性心肌梗死(203例,占37.7%),不明原因(77例,占14.3%)以及其他心脏原因(61例,占11.3%);初始心律类型主要为无脉电活动(215例,占40.0%)和心跳停止(179例,占28.0%)。共195例患者复苏成功,复苏成功率为36.2%。与复苏成功组比较,复苏失败组的发病至开始复苏时间(min:14.94±1.03比9.02±1.05)、发病至肾上腺素开始使用时间(min:8.50±0.02比4.21±0.16)、发病至气管插管成功时间(min:9.56±1.87比5.86±0.84)、行CPR总时长(min:48.75±1.73比35.39±2.51)均明显延长(均P<0.05),累计肾上腺素用量明显增加(mg:8.48±4.81比6.31±4.86,P<0.05)。两组患者发病地点、心搏骤停主要原因均有明显差异(均P<0.05),但性别、年龄、初始心律类型及使用电除颤比例差异均无统计学意义(均P>0.05)。二元Logistic分析显示,发病至开始复苏时间〔优势比(OR)=1.763,95%可信区间(95%CI)为1.713~1.804,P=0.000〕、累计肾上腺素用量(OR=1.759,95%CI为1.708~1.765,P=0.000)、发病至气管插管成功时间(OR=1.023,95%CI为0.988~1.047,P=0.008)、发病至肾上腺素开始使用时间(OR=1.819,95%CI为1.785~1.946,P=0.002)均为复苏成功的危险因素(均P<0.05)。结论心源性疾病是心搏骤停的主要原因,发病至开始复苏时间、累计肾上腺素用量、发病至气管插管成功时间、发病至肾上腺素开始使用时间为急诊科CPR成功的独立影响因素。
Objective To analyze the clinical data and characteristics of patients undergoing cardiopulmonary resuscitation(CPR)in the emergency department and the factors affecting the success of resuscitation,so as to allocate medical resources in emergency department,improve the CPR process and increase the success rate of CPR.Methods 538 patients with cardiac arrest who were registered by Utstein in the emergency department of the Third Central Hospital of Tianjin from December 2009 to December 2019 were selected as study subjects.The clinical data and characteristics were analyzed.According to whether the resuscitation was successful,the patients were divided into successful group and failed group,and the factors influencing success of resuscitation were analyzed.Results A total of 538 patients were enrolled in this study,with an average age of(65.53±15.56)years old.The number of patients aged 71-80 years old was the largest(145 cases,27.0%),followed by those aged 61-70 years old(105 cases,19.5%)and 51-60 years old(99 cases,18.4%).The main causes of cardiac arrest were acute myocardial infarction in 203 cases(37.7%),unknown causes in 77 cases(14.3%)and other cardiac causes in 61 cases(11.3%).The initial types of heart rhythm were no pulse electrical activity(215 cases,40.0%)and cardiac arrest(179 cases,33.3%).In this study,195 patients were resuscitated successfully,and the success rate of recovery was 36.2%.Compared with the successful group,the time of onset to resuscitation(minutes:14.94±1.03 vs.9.02±1.05),start time of epinephrine application(minutes:8.50±0.02 vs.4.21±0.16),time of onset to endotracheal intubation success(minutes:9.56±1.87 vs.5.86±0.84)and total duration of CPR(minutes:48.75±1.73 vs.35.39±2.51)in the failed group were significantly prolonged(all P<0.05),and the cumulative epinephrine dosage was significantly increased(mg:8.48±4.81 vs.6.31±4.86,P<0.05).There were significant differences in the location of onset and main causes of cardiac arrest between the two groups(both P<0.05),but there were no significant differences in gender,age,initial heart rate type and the proportion of defibrillation(all P>0.05).Binary Logistic analysis showed that the time from onset to resuscitation[odds ratio(OR)=1.763,95%confidence interval(95%CI)was 1.713-1.804,P=0.000],cumulative dosage of epinephrine(OR=1.759,95%CI was 1.708-1.765,P=0.000),time of onset to endotracheal intubation success(OR=1.023,95%CI was 0.988-1.047,P=0.008)and start time of epinephrine use(OR=1.819,95%CI was 1.785-1.946,P=0.002)were risk factors for successful resuscitation(all P<0.05).Conclusion Cardiogenic disease is the main cause of cardiac arrest,and the time from onset to resuscitation,cumulative dosage of epinephrine,success time of endotracheal intubation and time of epinephrine application are independent factors influencing the success of resuscitation in department of emergency.
作者
姜素文
尹彦斌
韩婷婷
陆宏达
王露
傅宝勤
韩振坤
王雪
韩理尧
高文卿
吴霄迪
Jiang Suwen;Yin Yanbin;Han Tingting;Lu Hongda;Wang Lu;Fu Baoqin;Han Zhenkun;Wang Xue;Han Liyao;Gao Wenqing;Wu Xiaodi(Department of Emergency,the Third Central Hospital of Tianjin,Tianjin 300170,China;Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Tianjin 300170,China;Tianjin Artificial Cell Engineering Technology Research Center,Tianjin 300170,China;Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Tianjin ECMO Treatment and Training Base,Tianjin 300170,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第12期1502-1505,共4页
Chinese Critical Care Medicine
基金
天津市自然科学基金(17JCQNJC10000)。
关键词
心肺复苏
UTSTEIN模式
复苏成功
急诊
Cardiopulmonary resuscitation
Utstein mode
Success of resuscitation
Emergency treatment
