心脏骤停后心肺复苏和心肺脑复苏成功病例的对比分析

目的 探讨影响心脏骤停患者成功脑复苏的相关因素.方法 回顾对比分析心脏骤停后成功心肺脑复苏(A组,n=38)和仅心肺复苏成功(B组,n=42)患者之间的相关指标,包括性别、年龄、原发疾病、心脏骤停原因、心脏骤停环境、心脏骤停相关时间和心肺复苏后相关治疗持续时间.结果 两组性别比和平均年龄比较差异无统计学意义(P＞0.05).原发疾病:A组以外科为主(78.9%),B组以内科为主(61.9%),两组比较差异有统计学意义(P＜0.005).心脏骤停原因:A组31例(81.6%)为急性缺氧、低血压、内脏神经反射和单纯心脏疾患, B组30例(71.4%)为慢性缺氧和慢性心脏病,两组比较差异有统计学意义(P＜0.005).心脏骤停环境:A组24例(63.2%)发生在手术室和ICU,B组22例(52.4%)发生在普通病房,两组比较差异有统计学意义(P＜0.005).心脏骤停相关时间:A组心脏骤停持续时间(8.2±8.7)min,自主心跳恢复时间(6.7±8.4)min,脑缺血缺氧时间(1.5±1.3)min,均明显短于B组[分别为(30.8±26.2)min、(27.7±24.9)min和(3.1±3.1)min,P＜0.001或P＜0.005].心肺复苏后相关治疗持续时间:A组亚低温持续时间(4.0±2.6)d,呼吸机持续时间(11.1±19.7)d,与B组[(5.9±3.8)d和(15.4±29.3)d]比较差异无统计学意义(P＞0.05).Logistic多因素回归分析显示,原发疾病(OR=6.22,95%CI 1.64～23.46)、心脏骤停持续时间(OR=1.11,95%CI 1.04～1.19)和心脏骤停发生环境(OR=4.51,95%CI 1.22～16.61)与成功脑复苏的关系更密切,成为三个独立影响因素.结论 没有明显慢性疾病,在手术室和ICU以急性缺氧、低血压和单纯心脏原因发生的心脏骤停,抢救及时有效,复苏后处理恰当、合理,尽早实施全面脑保护是成功脑复苏的有利因素.

A retrospective study of successful CPR and CPCR after cardiac arrest

Objective To discuss the related factors of the cases with successful CPR and CPCR after cardiac arrest(CA). Methods Retrospective study of patients with successful CPCR (group A, n=38) and with only CPR(group B, n=42) were performed. Different factors were investigated including sex, age, primary diseases, lasting time of CA, reasons of CA and the managements after resuscitation. Results There was no significant difference in sex and age between two groups (P>0.05). The main primary diseases of group A and group B was surgical diseases (78.9%) and medical diseases (61.9%) respectively, P<0.005. The reasons of CA in group A (31, 81.6%) was acute hypoxia, hypotension, visceral reflex and cardiac diseases, and chronic hypoxia and chronic heart diseases in group B (30, 71.4%) , P<0.005. CA of 24 cases of group A happened in operation room and ICU (63.2%); CA of 22 cases of group B happened in general ward of hospital (52.4%), P<0.005. In group A, the lasting time of CA was (8.2±8.7)min, the recovery time of autonomous cardiac rhythm was (6.7±8.4)min and the brain hypoxia time was (1.5±1.3)min, which was shorter than that of group B [(30.8±26.2) min, (27.7±24.9)min and (3.1±3.1 min)], P<0.001 or P<0.005 respectively. There were no significant differences between hypothermia treatment of (4.0±2.6) days and a ventilation treatment of (11.1±19.7) days in the group A and (5.9±3.8) days and (15.4±29.3) days respectively in group B, P>0.05.Multivariate Logistic regression was also performed, the three independent influencing factors of successful CPCR was primary diseases(OR=6.22,95% CI 1.64～23.46), lasting time of CA (OR=1.11,95%CI 1.04～1.19)and circumstance of CA occurrence(OR=4.51,95%CI 1.22～16.61). Conclusion The following factor is key to successful CPCR: CA happens in operation room or ICU; the reasons of CA are acute hypoxia, hypotension, visceral reflex and cardiac disease; a prompt and proper emergency treatment; sufficient post-rescue treatment; a early and thorough brain protection.