院外心搏骤停患者的预后影响因素分析

Analysis of prognostic factors in patients with out-of-hospital cardiac arrest

目的探讨院外心搏骤停(OHCA)患者的预后影响因素。方法选择2016年3月至2019年10月台州市120急救中心派车到现场进行处置的OHCA患者3542例,收集并分析一般资料及心肺复苏术(CPR)信息。根据患者是否自主循环恢复(ROSC)分为复苏成功组和复苏失败组。采用多元logistic回归模型分析OHCA患者的预后影响因素。结果OHCA患者多发生于>60岁人群,其次为40~60岁人群,且多发生于患者家中,其次为工作场所。79.95%的OHCA发生在7∶00~<23∶00,急救反应时间多超过10 min,骤停原因多为心源性,且心室颤动和无脉性室性心动过速(即可电击心律)接近半数,多数OHCA患者有目击者,但由目击者进行CPR者极少,且复苏时间几乎都<10 min,院外行除颤、气管插管及使用肾上腺素患者占比较低。复苏成功组和复苏失败组急救反应时间、骤停原因、有无目击者、目击者CPR、复苏时间、院外除颤比较,差异均有统计学意义(均P<0.05)。急救反应时间、目击者CPR、复苏时间、院外除颤均是OHCA患者ROSC的独立影响因素(均P<0.05)。结论加强CPR知识普及,及时有效复苏是影响OHCA患者预后的主要因素。

Objective To explore the factors influencing prognosis of patients with out-of-hospital cardiac arrest(OHCA).Methods Clinical data of 3542 OHCA patients managed at the scene by first-aid personnel from 120 Emergency Center in Taizhou City from March 2016 to October 2019 were retrospectively analyzed.They were divided into successful resuscitation group and unsuccessful resuscitation group based on whether return of spontaneous circulation.Multiple logistic regression model was used to analyze the factors that affect the prognosis of patients.Results Most OHCA occurred in subjects aged>60 years,then was subjects aged 40-60 years.The most arrest place was patient's home,then was workplace.79.95%of OHCA cardiac arrest occurred from 7∶00-<23∶00.The emergency response time was generally more than 10 min.The main cause of arrest was cardiogenic arrest and more than half were ventricular fibrillation and pulseless ventricular tachycardia.Most OHCA patients were witnessed,but rare patients were received bystander cardiopulmonary resuscitation(CPR)and CPR duration was less than 10 minutes in most of them.Less patients underwent pre-hospital electrical defibrillation,endotracheal intubation and epinephrine administration.There were significant differences of emergency response time,arrest causes,whether witnessed,bystander CPR,CPR duration and electrical defibrillation between successful resuscitation group and unsuccessful resuscitation group(all P<0.05).Multivariate logistic analysis showed that emergency response time,bystander CPR,CPR duration,and pre-hospital defibrillation were independent factors affecting return of spontaneous circulation of OHCA patients(P<0.05).Conclusion Popularization of CPR knowledge,quick and effective CPR are the main factors for improving prognosis of OHCA patients.