上海市嘉定区院外心脏骤停流行病学与复苏结果调查

Epidemiology and outcomes from out-of-hospital cardiac arrests in Jiading District,Shanghai

目的调查嘉定区院外心脏骤停(OHCA)患者流行病学特点与复苏结果。方法回顾性收集2017年10月1日-2019年9月30日发生于嘉定区推测为疾病因素的、急救人员尝试心肺复苏(CPR)的成人(年龄≥18岁)OHCA患者的资料,包括人口学特征、呼叫者的特征属性、存活到院与存活出院。数据的报道采用国际通用的Utstein模式。采用Logistic回归分析等统计学方法,分析存活到院与存活出院率的影响因素。结果2年期间,急救人员尝试复苏案例514例(35.77%),推测为疾病因素的、急救人员尝试复苏的成人OHCA的粗发生率为每年16.06/10万,平均年龄(62.54±17.24)岁,男性占69.65%。大多数(74.71%)发生在家里或住所,旁观者CPR占比22.57%,没有发现公众除颤案例;导致心脏骤停的主要原因是心脏疾病(52.14%),初始心律为心搏停止者占85.80%、室颤(VF)和无脉性室速(VT)占4.09%。存活到院占比6.81%(95%CI:4.62%~8.99%),存活出院率为1.95%(95%CI:0.75%~3.14%),其中神经功能分类(CPC)为良好(CPC1/CPC2)占比0.97%。多因素回归分析发现,男性(OR=0.256,95%CI:0.111~0.590,P=0.001),初始心律为全心停搏(OR=0.078,95%CI:0.023~0.268,P=0.000)和基础气道(OR=0.020,95%CI:0.057~0.782,P=0.020)是院前能否自主循环恢复(ROSC)的独立预测因素;初始心律为心搏停止(OR=0.0,65,95%CI:0.009~0.465,P=0.006)和机械按压(OR=11.922,95%CI:1.471~96.607,P=0.020)是能否存活出院的独立预测因素。结论院外心脏骤停是嘉定地区居民重要死因,每100例患者中只有不到2例存活下来,改善预后的空间很大,及时除颤是OHCA患者能否存活的关键因素,应大力推广公共除颤和旁观者CPR,以改善患者预后。

Objective To investigate the epidemiological characteristics and resuscitation results of out-of-hospital cardiac arrest(OHCA)patients in Jiading District.Methods The data of OHCA patients(aged≥18 years old)who were suspected to be disease factors and tried cardiopulmonary resuscitation(CPR)in Jiading District from October 1,2017 to September 30,2019 were retrospectively collected,including demographic characteristics,characteristics of callers,survival to hospital and survival to discharge.The international Utstein model was used to report the data.Logistic regression analysis and other statistical methods were used to analyze the influencing factors of survival to hospital and survival to discharge rate.Results During two years,514 cases(35.77%)were resuscitated by emergency personnel.The crude incidence of OHCA was 16.06/100000/year,the average age was(62.54±17.24)years old,and 69.65% of them were male.Most of the cases(74.71%)occurred at home or residence,and bystander CPR accounted for 22.57%;The main causes of cardiac arrest were heart disease(52.14%).85.80% of the patients had asystole,4.09% had ventricular fibrillation(VF)and ventricular tachycardia(VT).The survival rate was 6.81%(95%CI:4.62%~8.99%),and the survival and discharge rate was 1.95%(95%CI:0.75%~3.14%),of which the good(CPC1/CPC2)was 0.97%in the neural performance category(CPC).Multivariate regression analysis showed that male(OR=0.256,95%CI:0.111~0.590,P=0.001),The initial rhythm was asystol(OR=0.078,95%CI:0.023~0.268,P=0.000)and basal airway(OR=0.020,95%CI:0.057~0.782,P=0.020)were independent predictors of ROSC;The initial rhythm was asystol(OR=0.0,65,95%CI:0.009~0.465,P=0.006)and mechanical compression(OR=11.922,95%CI:1.471~96.607,P=0.020)were independent predictors of survival and discharge.Conclusion Out of hospital cardiac arrest is an important cause of death in Jiading district.Less than 2 out of every 100 patients survive.There is a lot of room to improve the prognosis.Timely defibrillation is the key factor for the survival of OHCA patients.Public defibrillation and bystander CPR should be vigorously promoted to improve the prognosis of patients.