3796例院内心肺复苏患者的回顾性分析

Review of 3796 in-hospital patients with cardiopulmonary resuscitation

目的了解10年来院内心肺复苏(cardiopulmonary resuscitation,CPR)现状,探索如何提高CPR特别是脑复苏水平.方法对本院1995至2004年记录完整的3 796例患者资料进行院内CPR回顾性研究.对病例数量,疾病种类,CPR有关时程、实施地点、肾上腺素用量,心肺复苏成功率及脑复苏成功率等数据进行统计与分析.结果CPR病例数量逐年上升,21～50岁年龄段构成比增长显著,而10岁以下病例逐年减少;1999年起,创伤后CPR病例数量超过心血管病而跃居首位;心脏停搏时间大于10 min者CPR成功率明显低于10 min内开始CPR者(P＜0.001);全部病例CPR成功率为30.4%,24小时生存率3.6%,脑复苏成功率仅1.4%;CPR成功率与心脏停搏时间、肾上腺素用量、初期复苏地点等有关,ICU及手术室内CPR和脑复苏成功率相对较好,普通病房最低.结论院内CPR成功率较低,脑复苏成功率则极低.主要原因是早期生命支持'生存链'未得到切实应用.普及、加强院前和院内复苏标准化训练,完善急诊医学体系建设和管理,是提高CPR成功率的根本途径.

Objective To study the status of in-hospital cardiopulmonary resuscitation （CPR） in the past l0 years, and to explore ways to improve CPR success rate, especially cerebral resuscitation. Methods A restrospective study was carried out in 3796 in-patients who required CPR patients from 1995 to 2004. The number of CPR patients, disease categories, CPR related time, locations of carrying out CPR, adrenaline dose, CPR success rate and cerebral resuscitation rate were analyzed by CS2000 statistical software. Results The number of CPR patients rose quickly during the past tea years, especially in 21 to 50 year-old patients, but patients younger than 10 years old were reduced. Since 1999, the patients who had trauma accounted for the most. The success rate of CPR patients with CA time （TCA） 〉 10 min were less than those TCA 〈 10 min. The total CPR success rate was 30.4%, survival rate after 24 hours was 3.6%, cerebral resuscitation rate was only 1.4%. The CPR success rate was related with the CA time , adrenaline dose and the first location of carrying out CPR . There was relatively higher CPR success rate in intensive care unit （ICU） and operating room than in common wards. Conclusion The in-hospital CPR success rate is poor, especially cerebral resuscitation. The main reason is that the “survival chain” of basic life support hasn＇t been applied completely. The fundmental way to improve the CPR rate is to popularize and strengthen the standardization of CPR training, and improve the establishment and administration of the emergency medical service system.