体外心肺复苏启动前因素对患者预后的影响

Influence of factors before initiation of extracorporeal cardiopulmonary resuscitation on the prognosis of patients

目的分析体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)启动前因素对患者预后的影响,以探讨ECPR的干预时机和改进策略。方法回顾性分析2018年7月至2021年4月在湖南师范大学附属第一医院(湖南省人民医院)行ECPR的29例患者。按患者是否存活出院分为生存组(n=13)及死亡组(n=16),分析两组常规心肺复苏(conventional cardiopulmonary resuscitation.CCPR)时间(开始心肺复苏到体外膜肺氧合运转的时间)、ECPR前初始心律、院外及院内心搏骤停的构成比、外院转运病例构成比。按CCPR时间分为≤45 min组、45-60 min组及>60 min组分别比较其出院存活率及持续自主循环恢复(sustained returm of spontancous circulation,ROSC)率。本院院内心搏骤停患者按心搏骤停(cardiac arest,CA)发生地点分为本科室亚组和其他科室亚组,比较其存活率。结果29例患者总体生存率44.83%,体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)平均辅助时长114(33.5,142.5)h,CCPR平均时长60(44.5,80)min。生存组ECMO辅助时间(140.15±44.80)h较死亡组长(P=0.001),生存组CCPR时间明显低于死亡组(P=0.010)。初始心律为可除颤心律组生存率更高(P=0.010)。OHCA较HCA患者病死率高(P=0.020)。外院转运病例病死率高于本院病例P=(0.025)。CCPR时间≤45min、45-60 min、>60 min三组患者出院生存率依次递减(P=0.001),ROSC率依次递减(P=0.001)。本院院内心搏骤停患者,CA发生地点在本科室(急诊医学科)组与其他科室组生存率差异无统计学意义(P=0.54)。结论ECPR出院存活率高于国内外报道的CCPR存活率,ECPR对难治性心搏骤停是有效的。ECPR的预后跟CCPR时间、CA初始心律、CA发生地点明显相关,提高ECPR存活率需加强宣教及团队建设。

Objective To analyze the influence of factors before initiation of extracorporeal cardiopulmonary resuscitation(ECPR)on the prognosis of patients,so as to explore the intervention timing and improvement strategy of ECPR.Methods A retrospective analysis was performed on 29 patients who underwent ECPR in the First Affiliated Hospital of Hunan Normal University(Hunan people's Hospital)from July 2018 to April 2021.Patients were divided into the survival group(n=13)and death group(n=16)according to whether they survived at discharge.The duration of conventional cardiopulmonary resuscitation(CCPR),initial heart rate before ECPR,the ratio of out-of hospital cardiac arrest(OHCA)and in-hospital cardiac arrest(IHCA),and the ratio of transported cases outside the hospital were compared between the two groups.According to diflerent CCPR time,the patients were divided into the W 45 min group,45-60 min group and>60 min group to compare the hospital survival and sustained return of spontaneous circulation(ROSC)rate.According to the location of cardiac arrest,the patients from emergency department and other department were divided to compare the survival of IHCA.Results The total survival rate was 44.83%,the average duration of extracorporeal membrane oxygenation(ECMO)was 114(33.5,142.5)h.and the average duration of CCPR time was 60(44.5,80)min.The duration of ECMO was longer in the survival group than in the death group(P=0.001).The duration of CCPR(the time from CPR to ECMO)in the survival group was significantly shorter than that in the death group(P=0.010).Patients with defibrillatory rhythm had higher hospital survival rate(P=0.010).OHCA patients had higher mortality than IHCA patients(P=0.020).Mortality of patients transferred from other hospitals was higher(P=0.025).Hospital survival and ROSC decreased in tum by CCPR duration W 45 min,45-60 min,and>60 min(P=0.001).The location of CA occurrence had no impact on the hospital survival rate of IHCA patients(P=0.54).Conclusions Hospital survival of ECPR is higher than that of CCPR.ECPR is effective for refractory cardiac arrest.The prognosis of ECPR is significantly related to the duration of CCPR,initial heart rate,and location of CA.Education and team training should be strengthened to improve the survival rate of ECPR.