Utstein模式下心源性心脏骤停心肺复苏的危险因素研究

目的:探讨影响Utstein模式下急诊心源性心脏骤停(CA)患者心肺复苏(CPR)预后的危险因素。方法:选取按Utstein模式要求登记的228例CA患者,记录患者CPR预后情况,对影响CA患者CPR预后的相关因素进行单因素及Logistic多因素分析。结果:228例CPR患者中,自主恢复循环(ROSC)125例(54.82%)、24 h存活55例(24.12%)、出院存活28例(12.28%)、神经功能恢复良好出院20例(8.77%)。经Logistic多因素分析显示,CPR持续时间、创伤性、首次监测心律、肾上腺素应用剂量是ROSC的独立预测因子;CPR持续时间、创伤性、首次监测心律是影响患者24 h存活的独立危险因素;首次监测心律、CA前状态、CPR持续时间是影响患者神经功能恢复良好及出院后存活的独立预测因子。结论:创伤性是影响CA患者ROSC及24 h存活的独立危险因素,肾上腺应用剂量≤5 mg、可除颤心律、CPR持续时间≤15 min均是影响患者ROCS及24 h存活的保护因素。可除颤心律、CPR持续时间≤15 min是影响患者神经功能恢复及出院后存活的有利因素,而CA前多器官功能衰竭(MOF)/疾病终末期则是危险因素。

Research on the risk factors of resuscitation for cardiogenic cardiac arrest under the model of Utstein

Objective：To investigate the risk factors influencing the prognosis of cardiopulmonary resuscitation （CPR）in patients with emergency cardiogenic cardiac arrest （CA） under the model of Utstein.Methods：Two hundred and twentyeight CA patients were enrolled and prognosis of CPR were recorded.The related factors affecting prognosis of CPR in patients with CA were analyzed by logistic univariate and multi-variate analysis.Results：Among 228 CPR patients,125 cases （54.82%） restored spontaneous circulation （ROSC）,55 cases （24.12%） survived for 24 hours,28 cases （12.28%） alive during discharge,20 patients （8.77%） with good neurological recovery.Logistic regression analysis showed that CPR duration,traumatic etiology,initial heart rate monitoring,dosage of adrenaline were the independent predictors of ROSC.CPR duration,traumatic etiology,initial heart rate monitoring were the independent predictive factors for survival in patients for 24 hours.Initial heart rate monitoring,former state of CA,CPR duration were the independent predictors of patients with good neurological recovery and survival after discharge.Conclusions：Trauma was the independent risk factor in CA patients with ROSC and 24 hours survival.Dosage of adrenalin≤5 mg,cardiac defibrillation,CPR duration≤ 15 min are the protective factors affecting ROCS and 24 hours survival.Successful cardioverter defibrillation,CPR duration≤ 15 min are favorite factors for neurological recovery in survival patients after discharge,but antecedent multiple organ failure （MOF） / end-stage diseases are risk factors.