院内术后心脏停搏预后的影响因素分析

Analysis of prognostic factors for postoperative in-hospital cardiac arrest

目的:探讨院内术后心脏停搏患者心肺复苏后自主循环恢复(ROSC)和存活出院的相关影响因素。方法:按Utstein院内复苏模式中的要求选择性回顾分析术后心脏停搏62例患者的病历资料,探讨病因并对可能影响ROSC和存活出院的相关因素进行logistic回归分析。结果:62例院内术后心脏停搏病例中ROSC率与存活出院率分别为53.2%(33/62)和25.8%(16/62)。窒息和脓毒症是两个主要病因,分别占总病因的21.0%(13/62)和14.5%(9/62)。单因素的Logistic回归分析结果表明目击、可除颤心律、除颤、CPR开始时间、首次除颤时间和首次肾上腺素注射时间是影响ROSC的相关因素。年龄、可除颤心律、CPR开始时间、除颤、首次除颤时间和首次肾上腺素注射时间是影响存活出院相关因素。结论:术后气道窒息是院内术后心脏停搏的重要病因,应加强术后的呼吸道管理和护理。院内术后心脏停搏后出现可除颤心律应该尽快除颤,有利于患者的生存预后。

Objective To assess the factors impacting of return of spontaneous circulation(ROSC)and survived to discharge for postoperative in-hospital cardiac arrest.Method According to the requirements of Utstein template,we retrospectively analyzed 62 cases of postoperative in-hospital cardiac arrest.To explore the etiological factors and Logistic regression analysis of the factors that might affect ROSC and survived to discharge.Results A total of 62 postoperative in-hospital cardiac arrest were enrolled for analysis.The rate of ROSC and survival to discharge was 53.20%(33/62)and 25.80%(16/62)respectively.Asphyxia and sepsis were the two main causes,a uounting for 21.0%(13/62)and 14.5%(9/62)of the totel etiology respectively.From a Logistic regression analysis,the related factors of ROSC included witnessed,initial shockable rhythm,defibrillation,time to cardiopulmonaryresuscitation,time todefibrillation and time to epinephrine injection.The related factors of survived to discharge included age,initial shockable rhythm,time to cardiopulmonary,resuscitationdefibrillation,time to defibrillation and time to epinephrine injection.Conclusion Postoperative asphyxia is an important cause of postoperative in-hospital cardiac arrest.Postoperative respiratory management and care should be strengthened.Initial shockable rhythm of postoperative in-hospital cardiac arrest should be defibrillation as soon as possible,which is beneficial to the survival outcome of patients.