不复苏意愿相关因素分析

目的 探讨心肺复苏(CPR)中影响患者亲属提出不复苏(DNAR)意愿的患者自身相关因素.方法按Utstein模式要求登记温州医学院附属第一医院急诊科2005年1月至2008年12月院内心搏骤停(CA)患者522例,其中患者亲属提出DNAR意愿157例,为DNAR意愿组,其余365例为积极复苏意愿组.对患者年龄、性别、婚姻、户籍、CA病因、基础疾病、CA前活动状态、有无呼吸机辅助通气、有无使用升压药物等相关指标进行单因素Logistic回归分析,然后选择有统计学意义的变量进行多因素Logistic回归分析.结果 单因素Logistic回归分析发现性别、婚姻对患者亲属提出DNAR意愿无统计学意义(P>0.05),年龄、户籍、CA病因(心源性、创伤性)、中风、癌症、猝死、CA前活动状态、有无呼吸机辅助通气、有无使用升压药10个指标对亲属提出DNAR意愿有统计学意义(P<0.01).多因素Logistic回归分析发现影响亲属提出DNAR意愿的独立危险因素有年龄(P=0.034)、癌症(P=0.006)、中风(P=0.003)、CA前呼吸机辅助通气(P=0.000),而猝死是保护因素(P<0.01).CA病因中,心源性(P=0.020)和创伤性(P=0.000)也是保护因素.结论在与患者亲属提出DNAR意愿相关的患者自身因素中,年龄≥60岁、癌症、中风、CA前呼吸机辅助通气是肯定的因素,猝死及CA病因中的心源性、创伤性是否定的因素.

Analysis of factors influenceing patients' family to make decision to reject resuscitation to the patients

Objective To study the factors influenceing patients' family members to make own relative fac-tors patients' families making decision on refusal of cardiopulmonary resuscitation (CPR) to the critical patients. Method Data were registered based on Utstein Style of 522 patients aged over 15 years, who subjected to in-hos-pital cardiac arrest(CA) in Department of Emergency of The First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2008. A total of 157 patients' family made refusal decision among the 522 pa-tients, who belonged to the refusal group, and others belonged to the attempt resuscitation group. The associated factors included age, sex, marriage, household register, cause of CA, underlying diseases, capability of activity before CA, life supported with mechanical ventilation, and administration of pressor agents. The refusal decisions were evaluated by using univariate Logistical regression analysis, and then the statistical significant variables were analyzed by using muhivanate Logistical regression analysis. Results Age, household register, cause of CA(car-diac or traumatic),stroke, sudden death, cancer, capability of activity before CA, life supported with mechanical ventilation,and administration of pressor agents were the important factors of making refusal decision (P < 0.01), but sexes or marriage was insignificant related to the refusal decision (P > 0. O5). The independent risk factors re-lated to refusal decision were age (P = 0.034),cancer (P = 0.006),stroke (P = 0.003), and life supported with mechanical ventilation (P = 0.000) in multivariate Logistical regression analysis, but the protective factors were sudden death (P =0.000),cardiac CA (P =0.020) and traumatic CA(P =0.000). Conclusions Age over 60 years, cancer, stroke, and life suppoted with assisted ventilation before CA were factors associated with re-fusal decision making, yet sudden death, cardiac CA and traumatic CA were factors of accepting CPR.