郑州市院外心搏骤停普查及CPR预后相关因素:2016至2018年病例分析

Investigation of out-of-hospital cardiac arrest in Zhengzhou City and the risk factors of prognosis of cardiopulmonary resuscitation: case analysis for 2016-2018

目的分析郑州市院外心搏骤停(OHCA)患者急救情况,探讨影响OHCA患者心肺复苏(CPR)预后的相关因素。方法回顾性分析2016年6月至2018年6月郑州市紧急医疗救援中心接收的OHCA患者资料。收集患者性别、年龄、是否有旁观者、旁观者质量(医护人员、非医护人员)、120接诊时间段(白天/夜晚)、心搏骤停地点(居住地、公共场所、酒店、其他)、急救医疗服务(EMS)反应时间、CPR持续时间、首次监测到的心律、除颤、通气方式(球囊面罩、喉罩、气管插管)、肾上腺素用量、心搏骤停原因、复苏结果〔自主循环恢复(ROSC)或死亡〕。对影响CPR预后的因素进行单因素及多因素Logistic回归分析。结果①普查结果:2年间郑州市OHCA患者共计7728例,其中3891例在救护人员到达现场时已临床死亡,1413例放弃抢救,2424例经积极抢救后仅有51例ROSC。07:01至23:00接诊量达73.71%(5696/7728),23:01至07:00接诊量占26.29%(2032/7728);从120指挥中心接到求救电话至救护人员到达现场所用时间,即EMS反应时间为(9.36±6.75)min;心搏骤停多发生在患者居住地〔占61.61%(4761/7728)〕,其次是公共场所〔占16.19%(1251/7728)〕;男性发生心搏骤停概率大于女性〔63.11%(4877/7728)比36.89%(2851/7728)〕;60岁以上者占54.94%(4246/7728);心搏骤停原因以心源性为主〔占38.63%(2985/7728)〕,其次为创伤〔占19.16%(1481/7728)〕。②CPR预后相关因素:单因素分析显示,年龄、旁观者、120接诊时间段、CPR持续时间、首次监测心律、肾上腺素用量、心搏骤停原因与OHCA患者ROSC有关〔年龄:优势比(OR)=0.450,95%可信区间(95%CI)=0.257~0.787;旁观者:OR=6.446,95%CI=4.695~8.851;120接诊时间段:OR=1.941,95%CI=1.114~3.382;CPR持续时间:OR=0.163,95%CI=0.074~0.360;首次监测心律:OR=0.080,95%CI=0.042~0.155;肾上腺素用量:OR=0.423,95%CI=0.241~0.740;心搏骤停原因:OR=1.901,95%CI=1.091~3.314;均P<0.05〕。多因素Logistic回归分析显示:非医护人员为旁观者、医护人员为旁观者、首次监测心律为可除颤心律、CPR持续时间<10min、肾上腺素用量<5mg是OHCA患者ROSC的有利因素(非医护人员为旁观者:OR=24.552,95%CI=10.192~59.144;医护人员为旁观者:OR=36.960,95%CI=17.572~77.740;首次监测心律为可除颤心律:OR=0.036,95%CI=0.015~0.087;CPR持续时间<10min:OR=0.191,95%CI=0.069~0.526;肾上腺素用量<5mg:OR=0.259,95%CI=0.125~0.537;均P<0.01)。结论郑州市OHCA患者男性多于女性,且以年龄大于60岁者多见;心搏骤停多发生在患者居住地,其次是公共场所;病因以心源性为主,其次为创伤;EMS反应时间稍长且复苏成功率较低,院前急救有待进一步提高。有旁观者、可除颤心律、CPR持续时间<10min、肾上腺素用量<5mg是OHCA患者CPR预后的有利因素。

Objective To analyze the first aid situation of patients with out-of-hospital cardiac arrest (OHCA) in Zhengzhou City, and to explore the related factors affecting the prognosis of cardiopulmonary resuscitation (CPR) in patients with OHCA. Methods Retrospective analysis of patients with OHCA admitted to Zhengzhou Emergency Medical Rescue Center from June 2016 to June 2018 was performed. General information of patients, such as gender, age, bystander, the quality of bystander CPR (medical personnel, non-medical personnel), 120 reception time (day/night), location (family, public place, hotel, other), emergency medical service (EMS) response time, duration of CPR, first detected heart rhythm, defibrillation, mode of ventilation (balloon mask, laryngeal mask, endotracheal intubation), epinephrine dose, cause of cardiac arrest, outcome of resuscitation [restoration of spontaneous circulation (ROSC) or death] were collected. The risk factors of CPR prognosis were analyzed with univariate and multivariate Logistic regression analysis. Results ① The result of general investigation: 7?728 cases with OHCA in the past two years, among whom 3?891 were clinically dead upon arrival, 1?413 were not rescued, 2?424 were actively rescued, and only 51 got ROSC. There were 73.71%(5?696/7?728) patients calling "120" during 07:01-23:00 and 26.29%(2?032/7?728) patients during 23:01-07:00. The response time of EMS was (9.36±6.75) minutes. Cardiac arrest mostly occurred at home, which accounting for 61.61%(4?761/7?728), followed by public places, which accounting for 16.19%(1?251/7?728). The incidence of cardiac arrest was higher in males than in females [63.11%(4?877/7?728) vs. 36.89%(2?851/7?728)]. 54.94%(4?246/7?728) of patients were over 60 years old. Cardiogenic factors were the most important etiology, which accounting 38.63%(2?985/7?728), followed by trauma, which accounting 19.16%(1?481/7?728).② The risk factors of prognosis of CPR: univariate Logistic regression analysis showed that age, bystander CPR, 120 reception time, duration of CPR, first detected heart rhythm, epinephrine dose and the cause of cardiac arrest were related to the ROSC in OHCA patients [age: odds ratio (OR)= 0.450, 95% confidence interval (95%CI)= 0.257-0.787;bystander CPR: OR = 6.446, 95%CI = 4.695-8.851;120 reception time: OR = 1.941, 95%CI = 1.114-3.382;duration of CPR: OR = 0.163, 95%CI = 0.074-0.360;first detected heart rhythm: OR = 0.080, 95%CI = 0.042-0.155;epinephrine dose: OR = 0.423, 95%CI = 0.241-0.740;cause of cardiac arrest: OR = 1.901, 95%CI = 1.091-3.314;all P < 0.05]. Multivariate Logistic regression analysis showed that non-medical personnel, medical personnel, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were favorable factors for ROSC in OHCA patients (non-medical personnel: OR = 24.552, 95%CI = 10.192-59.144;medical personnel: OR = 36.960, 95%CI = 17.572-77.740;shockable rhythm: OR = 0.036, 95%CI = 0.015-0.087;duration of CPR < 10 minutes: OR = 0.191, 95%CI = 0.069-0.526;epinephrine dose < 5 mg: OR = 0.259, 95%CI = 0.125-0.537;all P < 0.01). Conclusions ① Male patients with OHCA in Zhengzhou City were more than female patients, and the age of most patients was older than 60 years old. OHCA often happened at home, followed by public places. The etiology was mainly cardiogenic, followed by trauma. EMS response time was a little long, the success rate of recovery was low, and pre-hospital emergency treatment needs to be further improved.② Bystander CPR, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were beneficial to ROSC.