探索院内成功心肺复苏患者早期发生心血管衰竭的独立危险因素

Independent risk factors of patients with early cardiovascular failure after successful in - hospital cardiopulmonary resuscitation

目的探索院内成功心肺复苏患者早期发生心血管衰竭的独立危险因素，为临床工作者对预后评估提供依据。方法收集2010—12～2013—02入住我院急诊重症监护室院内心肺复苏成功（ROSC20min以上）的113例患者，并排除发病时未满18周岁、资料不完全、早期家属放弃抢救以及处于疾病终末期引起心脏骤停等病例。将入选的病例按复苏后是否出现早期心血管衰竭（ROSC后12h之内收缩压小于80mmHg，需用升压药物维持血压或原有高血压患者收缩压较基础水平下降20％）分为早期心血管衰竭组和非心血管衰竭组。采用相应的统计方法进行相关临床资料分析。结果入选病例113例，其中78例发生早期心血管衰竭（69．02％），死亡率87．18％，其余35例未发生心血管衰竭，死亡率为31．43％。本研究发现，未发生心血管衰竭组中有60％患者发病病因为心脏疾病。初始心律为非除颤心律（心脏停搏＋无脉电活动）、抢救时间过长、复苏前存在全身炎症反应综合症（SIRS）及血糖紊乱是早期发生心血管衰竭的危险因素，且早期发生心血管衰竭患者入室APACHEⅡ评分及SOFA评分明显高于未发生心血管衰竭组（P〈0．01或P〈0．05）。多因素Logistic分析得出，心肺复苏持续时间过长及复苏前存在SIRS、血糖紊乱是早期发生心血管衰竭的独立危险因素。结论本组研究院内成功心肺复苏患者中有69．02％早期发生心血管衰竭，死亡率较未发生心血管衰竭者明显增高，且入室APACHEⅡ评分及SOFA评分明显高于未发生心血管衰竭组；心肺复苏持续时间过长、复苏前存在SIRS及血糖紊乱是成功复苏后早期出现心血管衰竭的独立危险因素。

Objective To explore independent risk factors of patients with early cardiovascular failure after successful in - hospital cardiopulmonary resuscitation（CPR） in order to provide the basis of prognosis evaluation for clinical workers. Methods 113 successful cases from December 2010 to February 2013 were selected in EICU ward for the in - hospital CPR, and were divided into the early cardiovascular failure group and the non - cardiovascular failure group according to the appearance of early cardiovascuar failure. The relevant factors were analyzed by appropriate statistical methods. Results In 113 patients, 78 cases （69.02%）had early eardiovascuar failure, and the mortality rate was 87.18%. Cardiovascular failure did not occur in the remaining 35 cases, whose mortality rate was 31.43%. The onset disease of 60% patients in non - cardiovascular failure group was heart disease. The initial cardiac rhythm was non - defibrillator cardioverter （ cardioplegic and pulseless electrical activity）, the too long duration of CPR, pre - existing systemic inflammatory response syndrome （SIRS） and blood sugar disorder before CPR were all the risk factors of early cardiovascular failure. The patients with early cardiovascular failure had significantly higher APACHE II scores and SOFA scores than the patients without cardiovascuar failure（P 〈0.01 or P 〈 0.05 ）. Multivariate Logistic analysis showed that the long duration of CPR, pre - existing SIRS and sugar disorder before resuscitation were the independent risk factors of early cardiovascular failure. Conclusion 69.02% of successful CPR patients have early cardiovascuar failure, whose mortality, APACHE II scores and SOFA scores are higher than non - cardiovascuar failure patients. The too long duration of CPR, pre - existing SIRS and blood sugar disorder are independent risk factors of early cardiovascular failure after successful in - hospital CPR.