影响心肺复苏成功率的危险因素分析

Analysis of risk factors influencing successful rate of cardiopulmonary resuscitation

目的探讨影响心肺复苏（CPR）成功率的相关因素，为提高CPR成功率提供相应的指导。方法选择125例急诊科心搏、呼吸骤停成年患者的临床资料。根据是否插管分为插管组（79例）和面罩组（46例）；插管组按插管时机分为即刻插管组（≤5min，55例）和延迟插管组（5～15min，24例）；即刻插管组根据插管后接入装置再分为简易呼吸器组（接人人工球囊，21例）和呼吸机组（接呼吸机，34例）。以CPR后自主循环恢复（ROSC）维持≥2h为复苏成功。比较各组年龄、ROSC维持时间及复苏成功率。以ROSC维持时间为应变量，以性别、年龄、病因、通气方式、插管时机、连接方式为自变量进行逐步回归分析。结果各组间年龄比较差异无统计学意义（均P〉0．05）。插管组ROSC维持时间较面罩组明显延长（81．80h比30．71h，P〈0．01），即刻插管组较延迟插管组明显延长（43．69h比31．54h，P〈0．05），呼吸机组与简易呼吸器组比较差异无统计学意义（30．46h比24．02h，P〉0．05），延迟插管组较面罩组明显延长（31．54h比30．71h，P〈0．01）。复苏成功率在插管组明显高于面罩组（74．68％比8．70％），即刻插管组明显高于延迟插管组（81．82％比58．33％），呼吸机组明显高于简易呼吸器组（88．24％比71．43％，均P〈0．01）。多元回归分析显示，ROSC维持时间与年龄和插管时机均呈显著负相关（t1=-2．264，P1=0．025；t2=-5．341，P2=0．000）。结论早期CPR应尽可能进行气管插管，插管时机是影响CPR成功率的主要危险因素。

Objective To explore the influencing factors related to the successful rate of cardio- pulmonary resuscitation （CPR） in order to provide corresponding guidance for elevating the rate. Methods The clinical data were collected from 125 adult cases with cardiopulmonary arrest. According to whether a tube was inserted, all of them were divided into endotracheal intubation （EI） group （79 cases） and mask ventilation （MV） group （46 cases）. According to intubation time, EI group was subdivided into two subgroups： instant endotraeheal intubation （IEI） group （≤5 minutes, 55 cases） and delayed endotracheal intubation （DEI） group （5 - 15 minutes, 24 cases）. According to equipments connected, IEI group was again subdivided into two subgroups： simple ventilator group （with artificial saccule, 21 cases） and ventilator group （with ventilator, 34 cases）. The maintaining time ≥2 hours of return of spontaneous circulation （ROSC） after CPR was defined as a successful resuscitation. The age, ROSC maintaining time and resuscitation successful rates were compared among all groups. The ROSC maintenance time was as a variable, and the gender, age, etiology, ventilation mode, intubation time, connecting method were as the independent variables for stepwise regression analyses. Results There was no statistical significant difference in age among various groups （all P〉0.05）. ROSC maintaining time （hours） in EI group was significantly longer than that in MV group （81.80 vs. 30.71, P〈0. 01）, that in IEI group was significantly longer than that in DEI group （43.69 vs. 31.54, P〈 0.05）, and there was no statistical significant difference in ROSC maintaining time between ventilator group and simple ventilator group （30.46 vs. 24. 02, P〉0.05）. ROSC maintaining time in DEI group was significantly longer than that in MV group （31.54 vs. 30.71, P〈0. 01）. The resuscitation successful rate in EI group was significantly higher than that in MV group （74.68% vs. 8.70%, P〈0. 01）, that in IEI group was significantly higher than that in DEI group （81.82% vs. 58.33%, P〈0.01）, and that in ventilator group was significantly higher than that in simple ventilator group （88.24% vs. 71.43~, P〈0.01）. Multiple stepwise regression analyses showed that ROSC maintaining time was significantly negatively correlated with age and intubation time （t1 =- 2. 264, P1 = 0. 0253 t2 =- 5. 341, P2=0.000）. Conclusion This study suggests that we advocate the instant endotraeheal intuhation for early CPR, and the intubation time was the major risk factor of CPR successful rate.