老年创伤性与非创伤性疾病心肺复苏的临床对比分析

Comparative analysis of cardio-pulmonary resuscitation in the elderly patients with or without trauma

目的旨在寻找老年患者创伤性与非创伤性疾病心肺复苏(CPR)成功恢复自主循环(ROSC)的预测因素。方法将因心跳呼吸骤停收住入院的248例老年患者分为创伤性疾病组(n=159)和非创伤性疾病组(n=89),对2组病人的临床资料进行对比,采用回归分析,找出经CPR后成功ROSC的影响因素。结果经CPR后ROSC共89例,其中创伤组61例(38.36%),非创伤组28例(31.46%),2组比较无统计学差异(P=0.334);14例好转出院,其中创伤组2例(1.26%),非创伤组12例(13.48%),非创伤组明显高于创伤组(P<0.01)。创伤组以脑外伤发病率最高,腹部外伤ROSC的比例最高,胸部外伤ROSC比例最低。非创伤组心血管疾病发生率最高,ROSC比例也最高。最初心律为心室颤动(VF)的复苏成功率高于无脉性电活动(PEA)及心脏停搏组(P<0.01)。结论 CPR后成功ROSC,与基础疾病、最初的心脏节律、呼救至心肺复苏时间明显有关。

Objective To investigate predictors of restoration of spontaneous circulation（ ROSC） of cardio pulmonary resuscitation（ CPR） in the elderly patients with or without trauma. Methods 248 elderly patients who received CPR for cardiac arrest（ CA） were divided into two groups,according to whether being complicated with trauma.Regression analysis was used to identify the significant factors influencing ROSC. Results 89 patients got ROSC after receiving CPR,61（ 38. 36%） in the traumatic group and 28（ 31. 46%） in the nontraumatic group（ P = 0. 334）. Of the 14 patients who ultimately survived,2（ 1. 26%） were in the traumatic group and 12（ 13. 48%） in the nontraumatic ones（ P =0. 000）. The trauma mainly located at brain. In traumatic group,the rate of successful ROSC was highest in the patients with abdomen trauma,and lowest in the patients with thoracic trauma. In nontraumatic group,the incidence rate of cardiovascular diseases was highest,with highest rate of successful ROSC. The rate of ROSC in the patients initially diagnosed with ventricular fibrillation（ VF） and ventricular tachycardia（ VT） was significantly higher than that in the patients with PEA and asystolep（ P = 0. 000）. Conclusions Successful ROSC following CPR is closely related to the underlying disease,the initial diagnosis,the length of time between calling for help and beginning CPR.