院外心搏骤停特征及复苏影响因素分析

目的分析温州市区院外心搏骤停(OHCA)流行病学特征和影响复苏成功的相关因素,探讨院外急救如何提高心肺复苏成功率。方法从温州市区院前急救电子病历系统收集2020年1月至2021年10月温州市急救中心出警抢救的心搏骤停并行心肺复苏(CPR)的患者的临床资料,按复苏效果分为自主循环恢复(ROSC)组和无效组,比较年龄、性别、发病时间、发病地点、有无目击者、旁观者CPR、初始心律、应急反应时间、病因、院前高级生命支持情况的流行病学特征,采用单因素分析和Logistc回归分析心肺复苏的影响因素。结果收集OHCA 408例,其中男295例,女113例,年龄(61.26±19.78)岁,发生地多为家庭住宅,病因以心源性为主,分为ROSC组和无效组。单因素分析显示,有目击者,有旁观者CPR,应急反应时间≤10 min,院前成功建立气管插管,院前成功建立静脉通路用药存统计学差异(P<0.05),再经多因素Logistic回归分析,有目击者,有旁观者CPR,应急反应时间≤10 min是心肺复苏效果的主要影响因素。结论普及公众急救意识和技能,加快目击者启动EMSS速度,提高旁观者CPR率,缩短应急反应时间,是心肺复苏成功的关键。

Objective To analyze the epidemiological characteristics of the out-of-hospital cardiac arrest(OHCA)in hospitals of Wenzhou urban district and the related factors affecting the success of resuscitation and to explore how pre-hospital first aid in this area can improve the success rate of the cardiopulmonary resuscitation.Methods The clinical data of the patients with sudden cardiac arrest and cardiopulmonary resuscitation(CPR)who were rescued by Wenzhou Emergency Center from January 2020 to October 2021 were collected from the Pre-hospital Emergency Electronic Medical Record System in hospitals of Wenzhou urban district and divided into the ROSC group and the ineffective group according to the resuscitation effect.Subsequently,the age,gender,onset time,onset location,presence or absence of witnesses,bystander CPR,initial heart rhythm,emergency response time,etiology,and the epidemiological characteristics of the pre-hospital advanced life support were compared,and the univariate analysis and Logistic regression analysis were applied to study the influencing factors of cardiopulmonary resuscitation.Results A total of 408 cases of OHCA in Wenzhou urban district were collected,including 295 males and 113 females.The average ages were 61.2612±19.78 years.Most of the occurrences were family residences,and the etiology was mainly cardiac.The univariate analysis of the ROSC group and the ineffective group revealed that there were statistical differences in the following conditions:witness CPR,bystander CPR,emergency with the response time less than or same as 10 minutes,successful establishment of the tracheal intubation before hospital,successful establishment of the intravenous access medication before the hospital,with statistical significance(P<0.05).Then,the multivariate Logistic regression analysis indicated that the main influencing factors of the CPR effect were as follows:Witness CPR,bystander CPR,and emergency with the response time less than or the same as 10 minutes.Conclusion Popularizing the public emergency awareness and skills,encouraging the public to intervene early,increasing the CPR rate of the bystanders,speeding up the witnesses to activate the emergency medical services,and shortening the emergency response time are the keys to the success of CPR.