急救时间对院前心脏骤停患者心肺复苏成功率预测研究

Prediction of cardiopulmonary resuscitation in patients with pre- hospital cardiac arrest by first- aid time

目的探究急救时间(响应时间、场景时间和转运时间)对院前心脏骤停患者实施心肺复苏(CPR)成功率预测。方法选取2017年12月至2021年8月在院前急救"120"出诊后进行过CPR的331例院前心跳骤停患者为研究对象,以抢救成功与否进行分组。比较两组年龄、性别、病因、心电图类型和急救时间(包括响应时间、场景时间和转运时间),采用二元logistic回归分析CPR成功的影响因素,采用受试者工作特征(ROC)曲线分析响应时间预测CPR成功的敏感度和特异度。结果二元logistic回归显示,响应时间为CPR成功的影响因素。响应时间每增加1 min, CPR失败出现的概率增加1.160倍(95%CI:1.089~1.237,Wald=21.011,P<0.05)。ROC曲线分析显示,响应时间的面积为0.779(95%CI:0.718~0.840),最适切点为16.65 min时,约登指数为0.468,敏感度和特异度分别为69.9%、76.9%。结论响应时间可预测CPR的成功率,而场景时间和转运时间不影响CPR的成功率。

Objective To explore the prediction of the success rate of cardiopulmonary resuscitation in patients with pre-hospital cardiac arrest by first-aid time. Methods From December 2017 to August 2021,331 patients with pre-hospital cardiac arrest who had undergone cardiopulmonary resuscitation after 120 visits in pre-hospital firs-aid were selected as research objects, and were divided into groups according to whether the rescue was successful or not. Two groups were compared in age, gender, etiology, ECG type and emergency response time(including response time, scene time and transport time). The influencing factors of successful cardiopulmonary resuscitation were analyzed by binary logistic regression, and the sensitivity and specificity of response time to predict successful cardiopulmonary resuscitation were analyzed by receiver operating characteristics(ROC) curve. Results Binary logistic regression analysis showed that response time was an influencing factor for the success of cardiopulmonary resuscitation. For every 1 minute increase in response time, the probability of cardiopulmonary resuscitation failure increased by 1.160 times(95% CI: 1.089~1.237,Wald=21.011,P<0.05). ROC curve analysis showed that the area under the ROC curve of response time was 0.779(95% CI: 0.718~0.840), the optimal cut-off point was 16.65 min, the Youden index was 0.468, and the sensitivity and specificity were 69.9% and 76.9%, respectively. Conclusion Response time can predict the success rate of cardiopulmonary resuscitation, while scene time and transit time do not affect the success rate of cardiopulmonary resuscitation.