重症监护病房患者心室纤颤时间及心功能分级对除颤效果的影响

The effect of ventricular fibrillation time and NYHA classification on defibrillation in intensive care unit patients

目的了解重症监护病房患者除颤（DF）与心肺复苏（CPR）先后顺序以及心室纤颤（VF）时间和纽约心脏病协会（NYHA）心功能分级对DF效果的影响。方法将需要紧急DF的93例患者按VF发生时间分为〈4min组（53例）、4～8min组（24例）、〉8min组（16例）3组，每组再按先DF还是在5次循环的基本CPR后DF分为两个亚组。观察不同VF时间、DF和CPR先后顺序、不同NYHA心功能分级对DF成功率的影响。结果随VF时间的延长，DF成功率明显下降[VF〈4min、4—8min、〉8min组DF成功率分别为83．0％（44／53）、62．5％（15／24）、25．0％（4／16），两两比较均P〈0．01]。VF〈4min组，先DF者的DF成功率明显高于先CPR者[88．9％（24／27）比76．9％（20／26），P〈0．05]；VF4～8min组，先DF者的DF成功率略高于先CPR者[66．7％（8／12）比58．3％（7／12），P=0．09]；VF〉8min组，先CPR者的DF成功率明显高于先DF者[37．5％（3／8）比12．5％（1／8），P〈0．01]。随NYHA心功能分级增加，患者DF成功率逐渐下降[NYHAⅠ～Ⅳ级分别为96．4％（27／28）、80．0％（20／25）、47．8％（11／23）、29．4％（5／17），P〈0．05或P〈0．01]。结论心搏骤停VF持续时间及NYHA心功能分级是影响DF效果的重要因素；DF与CPR的先后顺序应结合心搏骤停VF持续时间区别对待；NYHA心功能分级较差者应提前做出某些预判及预防措施。

Objective To investigate whether the sequence of defibrillation （DF） and cardiopulmonary resuscitation （CPR）, duration of ventricular fibrillation （VF）, and New York Heart Association （NYHA） classification would affect DF result in intensive care unit. Methods Ninety-three cases needing instantaneous DF were divided into three groups according to VF lasting time： 〈4 minute group （n = 53 ）, 4 - 8 minute group （n = 24）, 〉 8 minute group （n= 16）, and each group was randomly divided into two sub-groups according to time sequence： the prior DF group or the prior CPR for five cycles followed by DF group （prior CPR group）. The effect of VF time, the sequence of DF and CPR, and NYHA classification on success rate of DF were observed. Results With prolonging VF time, success rate of DF obviously lowered [success rate of DF for VF 〈4 minute, 4 - 8 minute, and 〉8 minute groups were 83.0% （44/53）, 62.5% （15/24）, and 25.0% （4/16）, respectively, all P〈0.01]. When VF time lasted less than 4 minutes, success rate of DF in the prior DF group was obviously higher than that in the prior CPR group [88.9% （24/27） vs. 76.9% （20/26）, P〈0.05]. When VF time lasted for 4 - 8 minutes, the prior DF group had slightly higher success rate of DF compared with the prior CPR group [66.7% （8/12） vs. 58.3% （7/12）, P=0.09]. When VF time lasted longer than 8 minutes, the success rate of DF in the prior CPR group was obviously higher than that in the prior DF group [37.5% （3/8） vs. 12.5% （1/8）, P〈0.01]. The success rate of DF was lowered in higher NYHA classification [success rate of DF for NYHA classification Ⅰ -Ⅳ was 96.4% （27/28）, 80.0% （20/25）, 47.8% （11/23）, 29.4% （5/17）, respectively, P〈0.05 or P〈0.011- Conclusions VF lasting time and NYHA classification are key factors to success rate of DF, and the choice of sequence of DF and CPR depends on the lasting time of VF. For cases with the high NYHA classification, we should make some judgement beforehand and prepare some preventive measures.