浙江省院外心搏骤停流行病学及预后分析

Epidemiology and outcome of out-of-hospital cardiac arrest in Zhejiang province

目的分析浙江省院外心搏骤停（OHCA）患者的流行病学特征及与预后相关的因素，为提高心肺复苏（CPR）成功率提供依据。方法参照Utstein模式，收集2012年1月至2016年8月浙江省人民医院急诊科、宁波市急救中心和绍兴市急救中心接诊的493例OHCA患者的临床资料，分析其病因、发生地点、初始心律、有无目击者、有无目击者CPR、有无院外除颤、有无院外气管插管、有无院外使用肾上腺素、急救反应时间，以及现场／途中自主循环恢复（ROSC）、急诊室ROSC、存活入院、存活出院和出院时的神经功能状态等。分析与OHCA患者30d存活率相关的因素。结果人选493例OHCA患者中男性342例，女性151例；年龄（58．8±21．4）岁；心源性疾病219例，创伤155例，呼吸系统疾病22例，溺水19例，电击8例，其他70例。大部分患者OHCA发生在家里（65．1％）和公共场所（22．7％）；55．2％的OHCA患者有目击者，但只有2．6％由目击者进行CPR；初始心律为心室停搏者有78．7％，心室纤颤（室颤）或室性心动过速（室速）者仅有5．5％；院外除颤率只有6．9％；16．4％在院外接受了气管插管；56．4％在现场或急救车上使用了肾上腺素。急救反应时间为（13．6±8．0）min。4．5％的OHCA患者在现场／途中ROSC，7．7％在急诊室ROSC；只有9．7％存活人院，1．2％存活出院，0．8％在30d时仍在院。30d存活率为2．0％（10／493），0．8％存活出院且神经功能良好[脑功能分级（CPC）1-2级]。有目击者（3．31％比0．45％）、初始心律为室颤或室速（7．41％比1．72％）、目击者CPR（15．38％比1．67％）、院外除颤（8．82％比1．53％）、急救反应时间〈10min（3．57％比0．74％）均能改善患者30d存活率（均P〈0．05）。结论浙江省OHCA的复苏存活率不高，“院外生存链”中很多因素有待进一步改进。

Objective To investigate the epidemiological features of out-of-hospital cardiac arrest （OHCA） in Zhejiang and to analysis factors associated with outcomes for providing evidence on improving the success rate of cardiopulmonary resuscitation （CPR）. Methods Clinical data of 493 patients with OHCA collected from the emergency department （ED） of Zhejiang Provincial People＇s Hospital, Ningbo Emergency Medical Service Center and Shaoxing Emergency Medical Service Center from January 2012 to August 2016 were analyzed retrospectively. All the data were recorded following the Utstein style included causes of arrest, location of arrest, first arrest rhythm, witnessed by bystanders, bystander CPR, pre-hospital defibrillation, pre-hospital intubation, pre-hospital epinephrine administration, emergency medical services （EMS） response time, return of spontaneous circulation （ROSC） at scene/ enroute, ROSC at ED, admission to hospital, survival to hospital discharge and neurological outcomes at discharge. Factors associated with 30 days survival rate of patients with OHCA were analyzed. Results 493 patients were enrolled, of whom 342 were male and 151 were female. The average age was （58.8 ± 21.4） years. The causes of arrests consisted of cardiac etiology （219 cases）, trauma （155 cases）, respiratory disease （22 cases）, drowning （19 cases）, electrocution （8 cases） and others （70 cases）. Most of the events occurred at home （65.1%） and public places （22.7%）. 55.2% patients were witnessed by bystanders while bystander CPR was performed in only 2.6% cases. Asystole was the predominant rhythm （78.7%） observed by the ambulance crew at the arrest site while only 5.5% first arrest rhythms were ventricular fibrillation/ventricular tachycardia （VF/VT）. Only 6.9% patients underwent pre-hospital defibrillation. Pre-hospital intubations were attempted in 16.4% patients. Epinephrine was administered in 56.4% patients at scene or in ambulances. EMS response time was （13.6 ± 8.0） minutes. 4.5% patients had ROSC at scene/enroute and 7.7% had ROSC at ED. Only 9.7% patients were admitted to hospital and 1.2% discharged alive. 0.8% patients were still in hospital on 30th day. The 30-day survival rate was 2.0% （10/493） and only 0.8% patients had neurologically favorable survivals [with the cerebral performance category （CPC） score of 1 or 2]. Witnessed by bystanders （3.31% vs. 0.45%）,VF/VT as the first arrest rhythm （7.41% vs. 1.72%）, bystander CPR （15.38% vs. 1.67%）, pre-hospital defibrillation （8.82% vs. 1.53%） and EMS response time 〈 10 minutes （3.57% vs. 0.74%） could improve 30-day survival rate of OHCA significantly （all P 〈 0.05）. Conclusion Resuscitation survival of OHCA in Zhejiang province was unsatisfactory. Improvements are required in series aspects of OHCA survival chain.