心搏骤停患者院前急救现状调查研究——基于郑州院外心搏骤停患者的流行病学调查和转归分析

Investigation on the current situation of pre-hospital care for patients with cardiac arrest: epidemiological investigation and analysis of outcomes of patients with out-of-hospital cardiac arrest in Zhengzhou

目的分析郑州城区2016年9月10日至2017年9月9日院外心搏骤停患者(OHCA)的流行病学调查和转归。方法来自郑州120中心承担的前瞻性观察研究项目。根据Utstein建议,2016年9月10日至2017年9月9日在48家急救站服务近500万人口的郑州院前急救体系救治的OHCA患者发病率、人口学特征和转归均得到了报告。结果在共4 317例OHCA案例中,有1 049例接受了心肺复苏(CPR),急救反应中位时间为480 s,四分位范围为372～610 s,年龄中位数为63岁,四分位范围为50～77岁,其中72.35%为男性。大多数事件发生在家中(61.39%),旁观者目击85.03%的事件发生,只有44例(4.19%)实施了旁观者CPR,无人在急救车到达前进行电除颤。大多数事件有1个推定的心源性因素(87.42%),只有21例(2.00%)患者呈现室颤或无脉性室速,仅有14例(1.33%)出现自主循环恢复,其中6例(0.57%)出院存活。结论 OHCA是郑州城区患者院外死亡主因,只有不到1%患者获得存活;OHCA患者救治成功率不佳,可通过对公众开展CPR培训,提高调度员快速识别及电话指导能力,缩短急救反应时间,设置自动体外除颤器(AED)等综合措施来提高OHCA救治成功率。

Objective To assess the epidemiological investigation and outcomes of out-of-hospital cardiac arrests(OHCAs)in Zhengzhou urban area from September 10,2016 to September 9,2017.Methods Prospective observational study from Zhengzhou Emergency Medical Services.The incidence,demographic and outcomes of patients who were treated for an OHCA between September 10,2016 and September 9,2017 in 48 ambulance service(EMS)regions,serving a population of almost 5 million,were reported in accordance with Utstein recommendations.Results Out of the 4 317 OHCAs recorded,cardiopulmonary resuscitation(CPR)was initiated in 1 049 patients.Among the CPR-receivers(n=1 049),644 patients(61.39%)had collapsed at home,while 234 patients(22.31%)at a public place,of a median age of 63 years old,with their ages ranging from 50-77 years old.The median time interval from call to EMS arrival at the collapse location was 480 s(372,210 s),in which 72.4%were male.Of the 917 OHCA cases with cardiac aetiology,892 cases(85.03%)were witnessed,and basic CPR was performed by bystanders before arrival of the EMS personnel in 44 patients(4.19%)and none had defibrillation prior to the arrival of the ambulance.Of the OHCAs with cardiac aetiology,21 patients(2.00%)had shockable rhythms(ventricular fibrillation or pulseless ventricular tachycardia),restoration of spontaneous circulation was achieved in 14 patients(1.33%),and of the 6 patients(0.57%)who were discharged alive.Conclusion Out-of-hospital cardiac arrest is an important cause of death in zhengzhou.With less than a hundredth surviving;the success rate of OHCA patients in Zhengzhou urban area is not good.Survival rates were highest amongst those who received bystander CPR,public access defibrillation,conducted CPR training for the public,improved the ability of the dispatcher to recognize cardiac arrest and guided CPR by telephone,shorted the emergency response time,and other comprehensive measures.