影响老年创伤患者心肺复苏成功的危险因素分析

Analysis of risk factors affecting the success of cardiopulmonary resuscitation in elderly patients with trauma

目的研究影响急诊老年创伤患者心肺复苏成功的危险因素。方法回顾性分析2010年~2013年急诊行心肺复苏的120例老年创伤患者,男性74例,女性46例;年龄62~82岁,平均（73.42±6.25）岁。其中32例复苏成功,成功率26.67%。对120例患者的临床资料进行Pearson单因素分析和多因素Logistic回归分析。结果 Pearson单因素分析显示,患者的年龄（χ~2=19.342）、第一目击者急救（χ~2=8.661）、心肺复苏开始时间（χ~2=61.204）、复苏时患者心律（χ~2=13.208）、肾上腺素用量（χ~2=19.171）及基础疾病（χ~2=30.727）等因素与老年创伤患者心肺复苏成功有关（P均〈0.05）。Logistic回归分析显示,患者的年龄≥70岁[OR=1.627（95%CI：1.43~2.24）]、无第一目击者急救[OR=1.587（95%CI：1.36~2.04）]、心肺复苏开始时间〉5min[OR=1.513（95%CI：1.15~1.98）]、复苏时患者心律非室颤[OR=1.487（95%CI：1.07~1.84）]、肾上腺素用量〉5mg[OR=1.822（95%CI：1.52~2.31）]及有基础疾病[OR=1.423（95%CI：1.02~1.78）]为影响老年创伤患者心肺复苏成功的危险因素,P均〈0.05。患者格拉斯哥昏迷评分（GCS）和神经功能缺损评分（NFI）在3个月后均较治疗7d时有明显改善,差异均有统计学意义（P〈0.05）。结论影响急诊老年患者心肺复苏成功的危险因素包括患者的年龄、第一目击者急救、心肺复苏开始时间、复苏时患者心律、肾上腺素用量及基础疾病等。

Objective To study the risk factors affecting the success of cardiopulmonary resuscitation in elderly patients with trauma. Methods Retrospective analysis was conducted in 120 elderly trauma patients treated with cardiopulmonary resuscitation in the department of emergency in our hospital from 2010 to 2013. There were 74 males and 46 females,with an average of（ 73. 42 ± 6. 25） years（ ranging from 62 to 82 years）. Thirty-two cases were successfully resuscitated,with the success rate of 26. 67%. Pearson single factor analysis and multivariate Logistic regression analysis were performed to study the risk factors of the success of cardiopulmonary resuscitation.Results Pearson single factor analysis showed that the age of the patient（ χ~2= 19. 342）,the first witness aid（ χ~2=8. 661）,the heart and lung resuscitation time（ χ~2= 61. 204）,the patient＇s heart rate（ χ~2= 13. 208）,the amount of adrenaline（ χ~2= 19. 171） and basic diseases（ χ~2= 30. 727） were related to the success of cardiopulmonary resuscitation（ P 0. 05）. Logistic regression analysis showed that,patients older than 70 years[OR = 1. 627（ 95% CI： 1. 43-2. 24） ],no first responder[OR = 1. 587（ 95% CI： 1. 36-2. 04） ],cardiopulmonary resuscitation（ CPR） start time 5min[OR = 1. 513（ 95% CI： 1. 15-1. 98） ],cardiac non-ventricular fibrillation during resuscitation[OR = 1. 487（ 95% CI： 1. 07 ~ 1. 84） ],adrenaline dose 5mg [OR = 1. 822（ 95% CI： 1. 52-2. 31） ]and basic disease[OR =1. 423（ 95% CI： 1. 02-1. 78） ]were risk factors affecting the cardiopulmonary resuscitation in elderly trauma patients（ P 0. 05）. GCS and NFI scores after 3 months were significantly improved than those at the 7th d after treatment,with statistical significance（ P 0. 05）. Conclusion The risk factors offecting the success of the elderly patients with heart and lung resuscitation include the age of the patient,the first witness aid,the start time of CPR,the patient＇s heart rhythm,the amount of adrenaline and basic diseases.