标准心肺复苏技术并综合干预措施对院外心脏性猝死患者的影响分析

Analysis of the Influence of Standard Cardiopulmonary Resuscitation Technique and Comprehensive Intervention on Patients with Sudden Cardiac Death

目的分析对于院外心脏猝死患者而言,采取标准心肺复苏技术及综合干预措施的影响效果。方法2014年1月—2017年12月期间,方便选取依靠医务人员进行院前心肺复苏的心脏猝死(suddencardiacdeath,SCD)高危患者60例为对照组,心血管科内家属经过心肺复苏技术培训的SCD高危患者60例为观察组,分析组间复苏效果、自主循环恢复指标比较。结果观察组复苏总有效率45.00%、有效循环恢复率48.33%均显著高于对照组的16.67%、20.00%(t=11.2927,10.7071,P<0.01);观察组自主循环恢复时间(6.11±0.75)min显著缩短于对照组的(8.28±0.94)min(t=13.9777,P<0.01);观察组APACHEⅡ评分(20.63±9.48)分显著低于对照组的(24.96±11.94)分(t=2.2000,P<0.05);观察组心肺复苏开始时间(2.84±0.56)min、开始除颤时间(9.50±1.20)min均显著缩短于对照组(23.25±2.61)min、(21.93±2.38)min(t=59.2250、36.0618,P<0.05),而心肺复苏持续时长(50.35±5.61)min、入ICU时间(5.46±0.88)min均稍缩短于对照组(50.91±5.39)min、(5.52±0.93)min(t=0.5576、0.3630,P>0.05);观察组血乳酸水平(5.73±0.62)mmol/L、血清神经元特异性烯醇化(nenronspecificenolase,NSE)水平(30.10±7.48)μg/L均显著低于对照组的(11.09±1.35)mmol/L、(35.95±8.45)μg/L(t=27.9479、4.0154,P<0.05);观察组呼吸衰竭发生率13.33%、DIC率2.33%、脑疝率1.67%、肾衰竭率1.67%均显著低于对照组的30.00%、15.00%、26.67%。11.67%(χ^2=4.9100、4.9041、15.4198、4.8214,P<0.05);观察组存活率31.67%显著高于对照组的6.67%(χ^2=12.1022,P<0.05)。结论对于院外心脏猝死患者而言,对家属开展标准心肺复苏技术培训,并在患者发生心脏猝死第一时间予以心肺复苏,有利于缩短有效循环恢复时间,提升抢救成功率。

Objective To analyze the effect of standard cardiopulmonary resuscitation techniques and comprehensive interventions on patients with sudden cardiac death. Methods From January 2014 to December 2017, 60 patients with high-risk cardiac death(SCD) who were only relying on medical staff for pre-hospital cardiopulmonary resuscitation were convenient selected as the control group. Cardiopulmonary resuscitation was performed in families of cardiovascular families. 60 patients with high-risk SCD were trained in the observation group, and the recovery effect and independent circulation recovery index were compared between the groups. Results The total effective rate of resuscitation in the observation group was45.00%, and the effective circulation recovery rate was48.33%, which was significantly higher than 16.67% and20.00% of the control group(χ~2=11.292 7, 10.707 1, P<0.01). The spontaneous recovery time of the observation group was(6.11±0.75)min was significantly shortened in the control group(8.28 ±0.94) min(t=13.977 7, P <0.01);the APACHE Ⅱ score(20.63±9.48)points in the observation group was significantly lower than that in the control group(24.96±11.94)points(t=2.200 0, P<0.05);the onset time of cardiopulmonary resuscitation(2.84±0.56) min and the start defibrillation time(9.50±1.20) min were significantly shortened in the observation group(23.25±2.61) min,(21.93±2.38) min( t=59.225 0, 36.061 8, P<0.05), while the duration of cardiopulmonary resuscitation(50.35±5.61) min and ICU time(5.46±0.88) min were slightly shortened in the control group(50.91±5.39) min,(5.52±0.93) min(t=0.557 6, 0.363 0, P>0.05);blood lactate level(5.73±0.62) mmol/L and serum neuron specific enolase(NSE) level(30.10±7.48) μg/L, both were significantly lower than the control group(11.09 ±1.35) mmol/L,(35.95±8.45) μg/L(t=27.9479, 4.015 4, P<0.05);the incidence of respiratory failure in the observation group was 13.33%,DIC rate was 2.33%, cerebral palsy rate was 1.67%, and renal failure rate was 1.67%, which was significantly lower than30.00% and 15.00% of the control group of 26.67%. 11.67%(χ~2=4.910 0, 4.904 1, 15.419 8, 4.821 4, P<0.05);the survival rate of the observation group was 31.67% significantly higher than that of the control group 6.67%(χ~2=12.102 2, P<0.05).Conclusion For patients with sudden cardiac death outside the hospital, the family members should carry out standard cardiopulmonary resuscitation training and give cardiopulmonary resuscitation in the first time of sudden cardiac death,which will help shorten the effective cycle recovery time and improve the success rate of rescue.