影响院内心肺复苏的相关因素分析

Analysis of related factors influencing cardiopulmonary resuscitation in hospital

目的探讨院内心肺复苏(cardiopulmonary resuscitation,CPR)的影响因素,持续改进心脏骤停(cardiac arrest,CA)患者的救治措施,以提高CA患者的生存率和生存质量。方法回顾性分析2019年1月~2021年12月在我院不同科室发生CA实施CPR患者281例的临床资料,以自主循环恢复(return of spontaneous circulation,ROSC)为标准,观察不同科室进行CPR时的急救反应时间、胸外按压复苏开始时间、电除颤时间、气管插管时间、麻醉医生到场时间、患者年龄、性别以及ROSC成功率,并分析相关因素。结果各个科室发生CA并行CPR患者在发病年龄、性别方面比较,差异均无显著性(均P>0.05)。从病例分布来看,CA患者主要常见科室为急诊科、ICU、心肺病房居多。急诊科及ICU、手术室在急救反应时间、胸外按压开始时间、电除颤时间、气管插管时间方面比较,差异均无统计学意义(均P>0.05)。心肺病房、普通病房的患者行气管插管时间长于急诊科、ICU和手术室,但心肺病房所需急救反应时间、胸外按压开始时间、电除颤时间均优于普通病房,差异均有统计学意义(均P<0.05)。不同科室麻醉医生到达现场时间比较,差异无统计学意义(P>0.05)。院内ROSC成功率以急诊科最高,与各科室比较差异均有统计学意义(均P<0.05)。结论加强院内心脏骤停(in-hospital cardiac arrest,IHCA)的早期识别及尽早除颤意识,强化各个科室CPR培训,优化抢救流程,有利于提高患者ROSC成功率。

Objective To investigate the factors related to cardiopulmonary resuscitation(CPR)and to improve the treatment of cardiac arrest(CA)patients in order to improve the survival rate and quality of life of CA patients.Methods From January 2019 to December 2021,281 patients with CA and CPR were analyzed retrospectively.According to the standard of return of spontaneous circulation(ROSC),the first-aid response time,the beginning time of chest compression resuscitation,the time of defibrillation and the time of tracheal intubation were observed,the presence time of anesthesiologist and the success rate of ROSC were analyzed.Results There was no significant difference among the age and sex groups(all P>0.05).From the case distribution,CA patients mainly in the emergency department,ICU,cardiopulmonary ward in the majority.There were no significant differences in the first-aid response time,the beginning time of chest compressions,the time of defibrillation and the time of Endotracheal intubation(all P>0.05).The time of Endotracheal intubation in Cardiorespiratory Ward and General Ward is longer than that in emergency department,ICU and operating room,but the time of first aid response,the time of beginning of external chest compressions and the time of defibrillation in cardiorespiratory ward is better than that in general ward,the difference was statistically significant(all P<0.05).There was no significant difference in the time of arrival of anesthesiologists in different departments(P>0.05).The success rate of ROSC in hospital was the highest in emergency department.Conclusion Enhancing the early recognition and defibrillation awareness of in-hospital Cardiac Arrest(IHCA),strengthening CPR training in all departments,and optimizing rescue procedure are helpful to improve the success rate of patients with ROSC,it will provide reference for the establishment of medical emergency team(MET)in our hospital and reduce the occurrence of related medical disputes.