874例院外猝死临床分析与急救干预

Clinical analysis and emergency interference on 874 cases of prehospital sudden death patients

目的 分析探讨院外猝死及现场复苏成败的原因 ,以进一步提高现场复苏成功率 ,强化院外猝死的急救干预。方法 收集 1999年 1～ 12月经本中心院外急救的 874例猝死病历 ,参照Utstein模式进行资料报告方法统计 ,进行回顾性研究。结果 猝死前有心血管病史者占 70 44 % ;猝死高发年龄为 6 0～ 84岁 ,占 6 4 48% ,且男性多于女性 ;发病地点以家庭为主 ,占 93 8% ;先由目击者进行心肺复苏 (CPR)的 2 4例中 16例复苏有效 ,有效率 6 6 6 7% ,而后再由医生进行CPR的 815例中43例复苏有效 ,有效率仅为 5 2 8% ,二者差别有显著意义 (P <0 0 1) ;呼叫～到达现场平均间期在复苏有效组与无效组中分别为 8 16分钟和 9 90分钟 ;经除颤、气管插管后复苏有效率分别为 12 5 9%和 2 8 2 2 % ,面未用除颤、气管插管的有效率仅为5 89%和 1 92 % ,二者差别有显著意义 (P <0 0 1) ;现场复苏有效 5 8例 (6 91% ) ,复苏成功 1例 (0 12 % )。院外猝死率在 12个月中的高峰期为冬季。在平均一昼夜中的高峰点为早晨 7点。结论 降低院外猝死发生率的急救干预 :①要识别、防治猝死的高危因素 ;②在人群中普及以CPR为主的初级救护知识 ;③努力缩短急救反应时间即呼叫～到达现场间期 ;④要针对不同季节和时间 ,及时调整急救力?

Objective Analyze and approach sudden death and the reasons for the success and failure in on-the-spot resuscitation,in order to improve success rate in on-the-spot resuscitation.Methods Collected consecutive 874 records of sudden death patients who received prehospital emergency medical care provided by Shanghai medical Emergency Center during Jan.1999 through Dec.1999 and retrospective study was performed by referencing Utstein mode statistics.Results 70 44%of the patients had history of cardiovascular diseases before sudden death.High sudden death incidence happened in the age group of 60 to 84 years that accounted for 64 48% of all the patients;happened more often on males than on females;and happened basically at home,that accounted for 93 80%of all the patients.Among the 24 patients who received CPR by on-lookers,16(66 67%)were responded to the resuscitation.However,the 815 patients who received CPR by EMT,only 43(5 28%)of them were effective.The two results have significant differences ( P <0.01).The mean time interval from call to arrival at site,was 8 16 min and 9 90 min respectively in those who received resuscitation effectively and ineffectively.By using defibrillation and intubation,the effective rate of resuscitation was 12 59% and 28 22% respectively.In patients who didn’t received defibrillation and intubation,the effective rate were only 5 89% and 1 92%.It reveals significant differences ( P <0 01).There were 58 cases(6 91%)who responded to on-the-spot resuscitation and succeeded only on 1 case(0 12%).The incidence rate of prehospital sudden death patient was highest in winter and the peak happened at 7 am in a day.Conclusions The emergent interference death including:①identify,prevent and treat the high risk factors of sudden death;②popularize the knowledge of applying primary emergency care with CPR as the basic procedure;③make effort to shorten the emergency response time,i.e.time interval from call to arrival at site;④regulate resources according to the season and time. [