心肺复苏成败原因的探讨

Discussion on the reason for success or failure of cardiopulmonary resuscitation

目的探讨心肺复苏(CPR)成败原因,提高CPR的成功率。方法对我院急诊科2006年12月～2011年11月有完整资料记录的396例心搏骤停(CA)患者(晚期肿瘤,慢性疾病终末期除外)的救治进行回顾性分析,对CPR开始时间,地点、电击除颤、气管插管,机械通气等数据进行统计和分析。结果 165例5 min内开始CPR,抢救成功86例,成功率为52.1%;85例5～10 min开始CPR,抢救成功29例,成功率为34.1%;其余140例10 min后开始CPR,抢救成功0例,说明5 min内CPR成功率明显高于5 min后。院内CPR 140例,抢救成功80例,成功率为57.1%;院前CPR 256例,抢救成功35例,成功率为13.7%,说明院内CPR成功率明显高于院前CPR成功率;2 min内电陆除颤CPR成功率(54.2%)明显高于2 min后电陆除CPR成功率(34.0%);有气管插管CPR成功率(34.1%)明显高于无气管插管CPR成功率(13.0%);气管插管并接呼吸机CPR成功率为39.1%,明显高于未接呼吸机(包括气管插管和未气管插管的患者)CPR成功率(10.7%);差异均有高度统计学意义(均P<0.01)。结论尽早正确有效的CPR、电击除颤及熟练气管插管是CPR成功的关键,要提高CPR成功率必须加强专业急救队伍建设,建立完善急救网络,院前急救与院内急救密切配合,普及全民急救知识,从而进一步提高CPR成功率。

Objective To probe into the keys of CPR and improve the success rate of CPR. Methods 396 patients （except the late-stage cancer, the end-stage chronic disease） with a complete record of cardiac arrest （CA） in the emergency depart- ment from December 2006 to November 2011 were retrospectively analyzed, including the analysis of the statistical data of the CPR start time, place, electric defibrillation, tracheal intubation, and mechanical ventilation. Results 165 cases begin to CPR within 5 minutes, 86 cases were successfully rescued and the success rate was 52.1%; 85 cases begin to CPR be- tween 5 to 10 minutes, 29 cases were successfully rescued and the success rate was 34.1%; the other 140 cases begin to CPR after 10 minutes, 0 cases were successfully rescued, which indicates that the success rate within 5 minutes was sig- nificantly higher than after 5 minutes; 140 hospital treatment CPR cases, 80 cases were successfully rescued and the suc- cess rate was 57.1%, and 256 pre-hospital treatment CPR cases, 35 cases were successfully rescued and the success rate was 13.7%, which indicates the success rate of hospital treatment was significantly higher than that of the pre-hospital treatment; the success rate of CPR using electric defibrillation within 2 minutes was 54.2%, which was much higher than 34.0% success rate of CPR using electric defibrillation after 2 minutes ; the success rate of CPR with endotracheal intuba- tion was 34.1%, much higher than a 13.0% success rate of CPR without endotracheal intubation; the success rate of CPR with both endotracheal intubation and breathing apparatus was 39.1%, much higher than a 10.7% success rate of CPR without breathing apparatus （including patients with and without endotracheal intubation）, differences were statistically sig- nificant （all P 〈 0.01）. Conclusion Early correct and effective CPR, electric defibrillation and endotracheal intubation are the keys to the success of CPR. To improve the success rate of CPR, professional first aid team construction was strenghened, emergency network was established and improved, and cooperate hospital treatment closely with pre-hospital treatment and the national first aid was popularized so as to further improve the success rate of CPR.