老年人院外心搏骤停的相关因素及预后分析

Clinical characteristics and prognosis of elderly patients with OHCA

目的探讨老年院外心搏骤停(OHCA)患者的临床特点及预后因素。方法选取2018年1月至2019年1月石家庄急救中心院外出诊遇到的年龄60岁以上老年OHCA 752例,对老年OHCA患者的临床特征进行统计分析,并对其中复苏成功41例患者与复苏失败者40例进行对比,探求复苏成功的原因及预后因素。结果老年OHCA 752例患者中,70~80岁患者最多,平均年龄(75.0±2.4)岁,男性患者明显高于女性(P<0.05);因病所致心搏骤停占大多数(90%),多发生在家中(69.9%);引起心搏骤停的原因分析,心血管疾病所致的心搏骤停最多(80.2%);老年OHCA复苏成功者气管插管时间、开通静脉通路时间、开始实施CPR的时间均小于复苏失败组(P<0.05),其中伴有胸痛症状者的复苏成功率高于复苏失败组(P<0.05),而2组伴有呼吸困难、意识丧失、肾上腺素的应用率差异无统计学意义(P>0.05);分析41例复苏成功者,预后良好组低灌注时间明显短于预后不良组(P<0.05),预后良好组血乳酸、肌酐明显低于预后不良组(P<0.05),2组初始心律室颤/室速、无灌注时间差异无统计学意义(P>0.05)。结论院外男性老年患者心搏骤停发生率高,采取及时有效措施可提高复苏成功率,合并胸痛的患者复苏成功率高,可作为预后因素;低灌注时间、血乳酸及肌酐水平与复苏后预后良好密切相关。

Objective To investigate the clinical characteristics and prognosis of elderly patients with out-of-hospital cardiac arrest(OHCA).Methods A total of 60 patients with OHCA(over 60 years of age)who were diagnosed in our hospital from January 2018 to January 2019 were enrolled in the study.The clinical characteristics of patients were statistically analyzed,moreover,the reasons for reanimation success and the prognostic factors were analyzed and compared between the 41 patients with resuscitation success and the 41 patients with resuscitation failure.Results In the 752 elderly patients with OHCA,most of them were 70~80 years of age,with an average age being(75.0±2.4)years,of whom,the males were significantly more than females(P<0.05),and most of them had sudden cardiac arrest(90%),and mostly happened at home.the reasons of resulting in sudden cardiac arrest were mostlt by cardiovascular diseases(80.2%).In addition the tracheal cannulation time,pathway setup time and CPR beganning time in resuscitation success group were significantly shorter than those in resuscitation failure group(P<0.05).However there were no significant differences in symptom dyspnea,loss of consciousness and adrenaline usage between the two groups(P>0.05).Moreover the levels of lactate and creatinie in good prognosis group were significantly lower than those in poor prognosis group(P<0.05),but there were no significant differences in the initial rhythm VF/VT and no flow time between the two groups(P>0.05).Conclusion The incidence of male elderly patients with OHCA was higher.To take timely and effective treatment measures can improve the resuscitation success.Moreover the low flow time and the levels of lactate and creatinie are closely correlated with the prognosis of patients.