心搏骤停患者初始心律影响因素分析

Influencing Factors of Cardiac Arrest Patients with Initial Rhythms

目的了解心搏骤停患者初始心律的情况和一般临床特征,探讨心搏骤停患者初始心律为不可电击心律的危险因素,为该类疾病的防治提供理论依据。方法选取2014年4月—2016年4月中国人民解放军陆军总医院、首都医科大学附属北京友谊医院、卫生部北京医院发生于院前及急诊科的非创伤性心搏骤停患者232例,根据初始心律分为可电击心律32例(13.8%),不可电击心律200例(86.2%)。记录患者的性别、年龄、心搏骤停病因、基础疾病、心血管有创检查及治疗史、心血管类处方药物服用史等。采用多因素Logistic回归分析心搏骤停患者初始心律的影响因素。结果可电击心律与不可电击心律患者年龄,心源性猝死、重症感染发生率、冠状动脉疾病(CAD)、慢性阻塞性肺疾病(COPD)检出率,β-受体阻滞剂服用率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,重症感染、CAD、COPD、服用β-受体阻滞剂史是心搏骤停患者初始心律的影响因素(P<0.05)。结论重症感染、COPD、服用β-受体阻滞剂史是心搏骤停患者初始心律为不可电击心律的高危因素,其可能降低了心搏骤停患者可电击心律的发生;而具有CAD病史的患者发生心搏骤停时的初始心律多表现为可电击心律。

Objective To evaluate the distribution of initial rhythms and general clinical characteristics of patients with cardiac arrest,and to investigate the risk factors for cardiac arrest patients with initial non-shockable rhythms,so as to provide a theoretical basis for the prevention and management of this kind of disease. Methods We enrolled 232 patients with cardiac arrest occurred in pre-hospital and Emergency Department of PLA Army General Hospital,Beijing Friendship Hospital,Capital Medical University,Beijing Hospital from April 2014 to April 2016. And the patients were divided into initial shockable rhythm group（ 32 cases,13. 8%） and initial non-shockable rhythm group（ 200 cases,86. 2%） based on the conditions of initial rhythms. The patient＇s gender,age,cause of cardiac arrest,basic diseases,history of invasive cardiovascular examination and treatment,history of prescription of cardiovascular drugs and so on were recorded. Multivariate Logistic regression was used to analyze the influencing factors for initial rhythms in cardiac arrest patients. Results The differences in terms of age,incidences of sudden cardiac death and severe infection,history of coronary artery disease（ CAD）,history of chronic obstructive pulmonary disease（ COPD）,medication history of beta-blocker between the initial shockable rhythm group and initial non-shockable rhythm group demonstrated statistical significance（ P〈0. 05）. Results of multivariate Logistic regression showed that severe infection,CAD,COPD,medication history of beta-blockers were the risk factors for initial rhythms cardiac arrest patients（ P〈0. 05）. Conclusion Severe infection, history of COPD, and beta-blocker medication history are high risk factors for cardiac arrest patients with initial non-shockable rhythms due to the incidence of initial shockable rhythms may be reduced;when cardiac arrest patients with a history of CAD,their initial rhythms more manifest as shockable rhythms.