院外心脏骤停患者心肺复苏影响因素分析及其对策

胡磊; 任菁菁; 邱艳

doi:10.16766/j.cnki.issn.1674-4152.003497

院外心脏骤停患者心肺复苏影响因素分析及其对策

doi: 10.16766/j.cnki.issn.1674-4152.003497

胡磊^{1, 2},
任菁菁^1, ,,
邱艳¹

1.
浙江大学医学院附属第一医院全科医学科，浙江杭州 310003
2.
杭州市临安区第一人民医院急诊科，浙江杭州 311399

基金项目:

浙江省医药卫生科技计划项目 2024KY1456

详细信息

通讯作者:
任菁菁，E-mail：3204092@zju.edu.cn

中图分类号: R541.78 R605.974
计量
- 文章访问数: 39
- HTML全文浏览量: 38
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-05
- 网络出版日期: 2024-07-20

Influence factors and countermeasures of cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients

HU Lei^{1, 2},
REN Jingjing^{1
, ,},
QIU Yan¹

1.
Department of General Practice, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China

摘要

摘要: 目的分析院外心脏骤停(OHCA)患者的临床特征和影响心肺复苏(CPR)成功的因素, 探讨目前救治存在的问题并提出合理有效的改进对策。方法选择2019年1月1日-2022年12月31日期间杭州市临安区第一人民医院急诊救治的229例OHCA并行CPR的患者为研究对象, 根据复苏结果分为复苏成功组(71例)和复苏失败组(158例)。采用Utstein模式回顾性分析影响OHCA患者复苏成功(ROSC)的相关因素, 通过与现阶段国内研究数据对比, 寻找目前我区救治存在的问题并提出合理有效的解决办法。结果单因素分析显示, 影响OHCA患者ROSC的因素为院前急救反应时间、有无第一目击者、有无即刻CPR、有无6 min内CPR、有无院前急救、首次监测心律类型、电除颤次数、电除颤时间、CPR总时长(P < 0.05)。多因素logistic回归分析显示, 院前急救反应时间(P=0.020)、有无6 min内CPR (P=0.002)为OHCA患者ROSC的独立影响因素。院前急救反应时间每增加一个单位, 复苏成功率降低约27.3%(95%CI: 0.557~0.950), 有6 min内CPR者复苏成功率较无6 min内CPR者增高约8.8倍(95%CI: 2.226~34.804)。结论缩短院前急救反应时间、心脏骤停发生后尽早进行高质量CPR能够有效提高OHCA患者ROSC成功率。
- 院外心脏骤停 /
- 心肺复苏 /
- 院前急救反应时间 /
- 第一目击者 /
- 培训
Abstract: Objective To analyze the clinical characteristics of patients with out-of-hospital cardiac arrest (OHCA) and identify the factors affecting the success of cardiopulmonary resuscitation (CPR).Additionally, explore the current treatment problems and propose rational and effective improvement strategies. Methods A total of 229 patients with OHCA and concurrent CPR, who received emergency treatment at the First People's Hospital of Lin'an District, Hangzhou City from January 1, 2019 to December 31, 2022, were selected as the research subjects.According to the resuscitation outcomes, they were categorized into a successful resuscitation group (71 cases) and a failed resuscitation group (158 cases).The Utstein model was used to retrospectively analyze the relevant factors affecting the success of OHCA patient resuscitation.By comparing it with current domestic research data, we aim to identify the existing problems in treatment and propose reasonable and effective solutions. Results Univariate analysis showed that several risk factors affecting the success rate of return of spontaneous circulation (ROSC) in OHCA patients.These factors included the pre-hospital emergency response time, presence or absence of witnesses, immediate CPR, presence or absence of CPR within 6 minutes, presence or absence of pre-hospital emergency, type of first monitored heart rhythm, frequency of defibrillation, duration of defibrillation, and total duration of CPR (P < 0.05).Multivariate logistic regression analysis showed that both pre-hospital emergency response time (P=0.020) and the presence or absence of CPR within 6 minutes (P=0.002) were independent risk factors for successful resuscitation in OHCA patients.Specifically, an increase in pre-hospital emergency response time was associated with a decrease in the success rate of resuscitation by approximately 27.3% per unit increase (95%CI: 0.557-0.950).Individuals who received CPR within 6 minutes had a significantly higher success rate compared to those without timely intervention, approximately 8.8 times higher odds for successful resuscitation were observed among this group (95%CI: 2.226-34.804). Conclusion Shortening the response time of pre-hospital first aid and performing high-quality CPR as soon as possible after the occurrence of cardiac arrest can effectively improve the success rate of ROSC in out-of-hospital cardiac arrest patients.
- Out-of-hospital cardiac arrest /
- Cardiopulmonary resuscitation /
- Pre-hospital emergency response time /
- First responder /
- Training

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表 1 2组OHCA患者一般资料比较

Table 1. Comparison of general data for two groups of out-of-hospital cardiac arrest (OHCA) patients

项目	复苏成功组 (71例)	复苏失败组 (158例)	统计量	P值
性别[例(%)]			0.832^a	0.362
男性	47(66.2)	114(72.2)
女性	24(33.8)	44(27.8)
年龄(x±s, 岁)	65.8±15.9	64.6±15.7	0.532^b	0.595
发病季节[例(%)]			5.723^a	0.126
春(3~5月)	14(19.7)	44(27.8)
夏(6~8月)	26(36.7)	36(22.8)
秋(9~11月)	15(21.1)	31(19.6)
冬(12~2月)	16(22.5)	47(29.8)
发病时刻[例(%)]			3.210^a	0.073
白天(08:00~19:59)	51(71.8)	94(59.5)
夜晚(20:00~07:59)	20(28.2)	64(40.5)
发病场所[例(%)]			18.480^a	＜0.001
居住地	52(73.2)	133(84.2)
公共场所	11(15.5)	25(15.8)
120途中	8(11.3)	0
注：^a为χ²值，^b为t值。

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表 2 2组OHCA患者基础疾病及心脏骤停原因比较[例(%)]

Table 2. Comparison of underlying diseases and causes of cardiac arrest in two groups of OHCA patients [cases (%)]

项目	复苏成功组 (71例)	复苏失败组 (158例)	χ²值	P值
高血压			0.119	0.730
无	35(49.3)	74(46.8)
有	36(50.7)	84(53.2)
糖尿病			3.227	0.072
无	51(71.8)	130(82.3)
有	20(28.2)	28(17.7)
心血管疾病			2.893	0.110
无	36(50.7)	99(62.7)
有	35(49.3)	59(37.3)
其他重大疾病			2.109	0.146
无	42(59.2)	109(69.0)
有	29(40.8)	49(31.0)
心脏骤停原因			6.699	0.244
心源性	34(47.9)	99(62.7)
呼吸系统	23(32.3)	38(24.0)
休克	1(1.4)	4(2.5)
高钾血症	6(8.5)	6(3.8)
其他重大疾病	7(9.9)	11(7.0)
注：其他重大疾病包括恶性肿瘤、严重脑卒中后遗症、重大器官移植术或造血干细胞移植术后、冠状动脉搭桥术后、严重肾功能衰竭等。

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表 3 2组OHCA患者复苏相关指标比较

Table 3. Comparison of resuscitation indicators between two groups of OHCA patients

项目	复苏成功组(71例)	复苏失败组(158例)	统计量	P值
第一目击者[例(%)]			35.680^a	＜0.001
无目击	3(4.2)	55(34.8)
有目击	58(81.7)	101(63.9)
EMS目击	10(14.1)	2(1.3)
即刻CPR[例(%)]			36.845^a	＜0.001
无	50(70.4)	154(97.5)
有	21(29.6)	4(2.5)
6 min内CPR[例(%)]			113.732^a	＜0.001
无	10(20.0)	145(94.1)
有	40(80.0)	9(5.9)
院前急救[例(%)]			6.256^a	0.012
无	6(8.5)	34(21.5)
有	65(91.5)	124(78.5)
院前急救反应时间[M(P₂₅, P₇₅), min]	10.0(6.5, 11.0)	16.0(12.0, 22.0)	-8.921^b	＜0.001
首次监测心律类型[例(%)]			40.865^a	＜0.001
不可除颤心律	54(76.1)	158(100.0)
可除颤心律	17(23.9)	0
电除颤[例(%)]			35.720^a	＜0.001
无	40(56.3)	119(75.3)
有	31(43.7)	39(24.7)
电除颤次数[M(P₂₅, P₇₅), 次]	1.0(0.0, 2.0)	0.0(0.0, 0.3)	-2.848^b	＜0.001
电除颤时间[M(P₂₅, P₇₅), min]	8.0(5.0, 17.0)	24.0(21.0, 28.0)	-6.390^b	＜0.001
院前静脉通路[例(%)]			29.867^a	＜0.001
无	54(76.0)	155(98.1)
有	17(24.0)	3(1.9)
院前气管插管[例(%)]			0.451^a	0.502
无	71(100.0)	157(99.4)
有	0	1(0.6)
院内静脉通路[例(%)]			-	-
无	0	0
有	71(100.0)	158(100.0)
静脉通路时间[M(P₂₅, P₇₅), min]	13.0(10.0, 15.0)	23.0(17.0, 31.0)	-9.219^b	＜0.001
院内气管插管[例(%)]			1.252^a	0.263
无	1(1.4)	9(5.7)
有	70(98.6)	149(94.3)
气管插管时间[M(P₂₅, P₇₅), min]	16.5(14.0, 18.0)	28.0(22.0, 36.8)	-10.142^b	＜0.001
累计肾上腺素用量[M(P₂₅, P₇₅), mg]	7.0(4.0, 9.0)	15.0(10.0, 20.0)	-9.302^b	＜0.001
CPR总时长[M(P₂₅, P₇₅), min]	21.0(12.0, 29.0)	44.5(30.0, 60.0)	-8.942^b	＜0.001
注：^a为χ²值，^b为Z值；“-”为未比较。

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表 4 变量赋值方法

Table 4. Methods of variable assignment

变量	赋值方法
院前急救反应时间	以实际值赋值
有无目击者	有目击者=1，无目击者=0
有无6 min内CPR	有6 min内CPR=1，无6 min内CPR=0
有无院前静脉通路	有院前静脉通路=1，无院前静脉通路=0

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表 5 院外心脏骤停患者自主循环恢复影响因素的多因素logistic回归分析

Table 5. Multifactorial logistic regression analysis of influencing factors for the return of spontaneous circulation in out-of-hospital cardiac arrest patients

变量	B	SE	Waldχ²	P值	OR(95% CI)
院前急救反应时间	-0.318	0.136	5.450	0.020	0.727(0.557~0.950)
有无目击者	-0.356	1.030	0.119	0.730	0.701(0.093~5.277)
有无6 min内CPR	2.175	0.701	9.612	0.002	8.801(2.226~34.804)
有无院前静脉通路	2.000	1.507	1.761	0.184	7.386(0.385~141.552)

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