影响急诊科心肺复苏效果的多因素分析

目的 寻找影响急诊科心肺复苏(CPR)效果的独立因素.方法 对照选择深圳市72家网络医院2004年9月至2009年1月急诊科进行过CPR的1 376例心脏停搏(CA)患者的调查表,用EpiData软件建立数据库,用SPSS 13.0软件进行两分类Logistic回归分析.结果 影响急诊科CA患者自主循环恢复(ROSC)的多因素分析显示,心室纤颤(VF)患者较心脏静止患者ROSC可能性大,相对比值比(OR)=3.071,P=0.000,95%可信区间(95%CI)=2.019～4.670;无脉搏电活动(PEA)较心脏静止患者ROSC可能性大,OR=1.730,P=0.036,95%CI=1.036～2.890;电击是ROSC的保护因素,OR=1.574,P=0.015,95%CI=1.093～2.265;肾上腺素累积剂量≤4 mg患者ROSC可能性较≥5 mg患者大,OR=1.483,P=0.037,95%CI=1.024～2.147;CA绝对时间是ROSC危险因素,OR=0.961,P=0.000,95%CI=0.946～0.976.影响急诊科CA患者生存入院的多因素分析显示,VF患者生存可能性大于心脏静止患者,OR=2.013,P=0.002,95%CI=1.299～3.121;肾上腺素累积剂量≤4 mg患者生存可能性较≥5 mg患者大,OR=2.289,P=0.000,95%CI=1.487～3.524;CA绝对时间是急诊科患者生存入院的危险因素,OR=0.951,P=0.000,95%CI=0.933～0.969.结论 急诊科CA患者ROSC的独立影响因素有:CA时心律、CA绝对时间、电击、肾上腺素累积剂量.急诊科CA患者生存入院的独立影响因素有:CA绝对时间、肾上腺素累积剂量、CA时心律.

A logistic regression analysis on the factors influencing effect of cardiopulmonary resuscitation in emergency department

Objective To look for the independent factors influencing the effect of cardiopulmonary resuscitation (CPR) in emergency department. Methods The data of patients involved in the study were retrieved from 72 network emergency hospitals in Shenzhen from September 2004 to January 2009. The data base was set up with EpiData software, according to questionnaires about cardiopulmonary arrest (CA)patients treated with CPR, and analyzed with SPSS 13.0 software. The binary Logistic regression was carried out with 8 factors which had emerged statistical significance through single factor analysis. Results A Logistic regression analysis on the factors influencing return of spontaneous circulation (ROSC) in emergency department showed the ventrical fibrillation VF, odds ratio (OR) = 3. 071, P = 0. 000, 95% confidence interval (95%CI)=2. 019 - 4. 670] and pulseless electric activity (PEA, OR=1. 730, P=0. 036,95%CI= 1. 036- 2. 890) were protective factors compared with asystole; electric shock was a protective factor (OR=1. 574, P=0. 015, 95%CI=1. 093 - 2. 265); adrenaline ≤4 mg group had higher likelihood of obtaining ROSC compared with group receiving ≥ 5 mg of adrenaline (OR = 1.483, P= 0.037,95%CI=1.024-2.147); duration of CA before CPR was a risk factor (OR = 0.961, P = 0.000,95%CI=0. 946-0. 976). A Logistic regression analysis on the factors influencing survival to admission in emergency department showed the VF was a protective factor compared with asystole (OR = 2.013,P=0. 002, 95%CI= 1. 299- 3. 121); adrenine ≤4 mg group had higher likelihood of survival to admission compared with group ≥5 mg (OR=2. 289, P=0. 000, 95 %CI=1. 487 -3. 524); duration of CA before CPR was a risk factor (OR = 0. 951, P=0. 000, 95%CI = 0. 933 - 0. 969). Conclusion Rhythm of heart, the duration of CA, electric shock and accumulated adrenaline dosage were independent influencing factors for ROSC in emergency department. Rhythm of heart, the duration of CA and accumulated adrenaline dosage were independent influencing factors for survival to admission in emergency department.