儿童重症监护病房心搏骤停心肺复苏短期预后相关因素分析

Analysis of Short-term Outcome-related Factors for Cardiopulmonary Resuscitation(CPR) in Treatment of Heart Arrestin Pediatric Intensive Care Unit( PICU)

目的探讨儿童重症监护病房(PICU)心搏骤停发生前及心肺复苏时的多种因素对心肺复苏短期预后的影响。方法 2011年4月—2013年4月中山大学附属第一医院PICU发生心搏骤停患儿94例,收集相关的人员、时间等系统因素以及心搏骤停发生前和心肺复苏时的干预措施,以心肺复苏成功,即恢复自主循环作为终点指标。采用多因素Logistic回归分析心肺复苏失败的相关因素。结果 94例心搏骤停患儿心肺复苏成功61例(65%),不同心搏骤停发生时间段、心搏骤停发生日期、管床护士经验、初级值班医生资质、上级值班医生资质,心搏骤停发生前是否应用机械通气、血管活性药物、镇痛,心肺复苏时是否接受肾上腺素、补钙、抗心律失常药物患儿心肺复苏失败率比较,差异均无统计学意义(P>0.05);不同入住PICU时间,心搏骤停发生前是否应用镇静药物、中心静脉通路,心肺复苏时是否接受正压通气、胸外按压、气管插管、补碱,不同心肺复苏时间患儿心肺复苏失败率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,心搏骤停发生前应用镇静药物,心肺复苏时接受正压通气、胸外按压、补碱及心肺复苏时间与心肺复苏失败有回归关系(P<0.05)。结论心肺复苏过程中接受胸外按压、补碱者以及心肺复苏时间≥30 min者心肺复苏失败率高,心搏骤停前应用镇静药物以及心肺复苏过程中接受正压通气者心肺复苏失败率低。

Objective To assess the impact of multiple factors（ including pre-arrest factors and CPR-related factors） on short-term outcome of cardiopulmonary resuscitation in treatment of cardiac arrest in PICU. Methods A total of 94 children with cardiac arrest who were treated with cardiopulmonary resuscitation in the PICU at the First Affiliated Hospital of Sun Yat-sen University from April 2011 to April 2013,were selected as study subjects. Systemic factors such as personnel-related factors and time-related factors,and intervention measures before cardiac arrest and during CPR were collected. The outcome variable was a successful resuscitation（ return of spontaneous circulation）. Multiple Logistic regression analysis was performed to identify the related factors for CPR failure. Results Among 94 children with cardiac arrest,61（ 65%） survived after CPR. The rate of CPR failure did not vary significantly by the onset time of cardiac arrest, the onset date of cardiac arrest, nurse experience,qualification of junior doctor on duty,qualification of superior doctor on duty,mechanical ventilation before onset of cardiac arrest,vasoactive drug use, sedative use, using phenylephrine, calcium or antiarrhythmic agent during CPR（ P〈0. 05）. The rate of CPR failure varied significantly by duration of PICU hospitalization, sedative use before onset of cardiac arrest,establishing central venous access before onset of cardiac arrest,receiving treatment with positive pressure ventilation,external chest compression,trachea cannula,alkali additives during CPR,duration of CPR（ P〈0. 05）. According to results of multiple Logistic regression analysis,sedative use before onset of cardiac arrest, receiving treatment with positive pressure ventilation,external chest compression and alkali additives during CPR,and duration of CPR have regressive relationships with CPR failure（ P〈0. 05）. Conclusion Receiving treatment with external chest compression and alkali additives during CPR,and the duration of resuscitation ≥30 min were independent predictors for CPR failure. Sedative use before onset of cardiac arrest,and positive pressure ventilation during CPR were beneficial factors for successful CPR.