心搏骤停患者入急诊抢救室时机与心室纤颤时间对除颤效果的影响

Effects of emergency admission to hospital time and ventricular fibrillation time on defibrillation results in patients with cardiac arrest

目的：了解心搏骤停患者入急诊抢救室的时间对复苏效果的影响和除颤与心肺复苏（CPR）先后顺序以及心室纤颤时间对除颤效果的影响。方法分析总结2011年1月~2014年12月期间工作时间和休息时间因心搏骤停进入急诊室抢救的162例患者,按心搏骤停发生至急诊抢救时间分为〈4 min组（82例）、4~10 min组（50例）、〉10 min组（30例）。每组患者再分为直接除颤组和先CPR再除颤组,分析比较不同室颤时间以及除颤、CPR先后顺序的除颤成功率。结果工作时间（日间）入抢救室的心搏骤停患者与休息时间（节假日及夜间）入抢救室的患者复苏率差异无统计学意义（P〉0.05）。随着室颤时间的延长,除颤的成功率明显下降。室颤时间〈4 min组、4~10 min组、〉10 min组除颤成功率分别为75.61%、56.00%、20.00%,室颤时间〉10 min组与〈4 min组、4~10 min组除颤成功率比较差异有统计学意义（P〈0.0167）。室颤时间〈4 min 组,先 CPR 再除颤组的除颤成功率与直接除颤组差异无统计学意义（77.50%比73.81%,P〉0.05）；室颤时间4~10 min组,先CPR再除颤组的除颤成功率明显高于直接除颤组（72.00%比40.00%, P〈0.05）；室颤时间〉10 min组,先CPR再除颤组的除颤成功率明显高于直接除颤组（40.00%比0,P 〈0.05）。结论心搏骤停的患者复苏成功率与在工作时间与休息时间入急诊抢救室的时机无明显关系,心搏骤停室颤持续时间是影响除颤效果的重要因素。

Objective To find out the effects of admission to emergency department time on cardiopulmo-nary resuscitation （CPR）results and the effects of the defibrillation and CPR sequence and ventricular fibrilla-tion time on defibrillation results in patients with cardiac arrest. Methods An analysis of clinical data for 162 patients with cardiac arrest who were admitted to the emergency room at working time and spare time be-tween January 2011 and December 2014 was done.Based on the length between cardiac arrest attack and admis-sion to emergency department,patients were divided into 〈4 min group （82 cases）,4~10 min group （50 ca-ses）,〉10 min group （30 cases）.Each group was subdivided into an immediate defibrillation group and a CPR before defibrillation group.The successful rate of defibrillation at different time of ventricular fibrillation,and with the sequence of defibrillation and CPR was comparatively analyzed. Results Comparing the successful rate of defibrillation for cardiac arrest patients admitted to the emergency room at working time （daytime）with patients admitted to the emergency room at spare time （holidays and nighttime）showed there was no statistical difference （P〉0.05）.With ventricular fibrillation prolonging,defibrillation success rate was significantly de-creased.In ventricular fibrillation 〈4 min group,4~10 min group and 〉10 min group,the success rate of de-fibrillation was 75.61%,56.00%,20.00%,respectively.Comparison of the defibrillation success rate in ven-tricular fibrillation〉10 min group with 〈4 min group and 4~10 min group yielded statistical difference （P〈0.0167）.In ventricular fibrillation〈4 min group,comparison the successful rate of defibrillation between CPR before defibrillation subgroup and immediate defibrillation subgroup showed no statistical difference （77.50%versus 73.81%,P〉0.05）.In ventricular fibrillation 4~10 min group,CPR before defibrillation subgroup had obviously higher success rate of defibrillation than immediate defibrillation subgroup,comparison between the two groups showed statistical difference （72.00% versus 40.00%,P 〈0.05）.In ventricular fibrillation〉10 min group,CPR before defibrillation subgroup had obviously higher success rate of defibrillation than immedi-ate defibrillation subgroup,comparison between the two groups showed statistical difference （40.00% versus 0,P〈0.05）. Conclusion The successful rate of resuscitation in patients with cardiac arrest has no relation to admission to emergency department at working time or at rest time.The duration of ventricular fibrillation in cardiac arrest is an important factor of affecting defibrillation results.