心搏骤停-心肺复苏患者30 d存活率相关影响因素分析--基于某三甲医院8年数据的研究

Analysis of relevant factors influencing the 30-day survival rate of patients with cardiac arrest and cardiopulmonary resuscitation:research based on 8-year data of a classⅢhospital

目的调查心搏骤停-心肺复苏(CA-CPR)患者存活情况,分析患者自主循环恢复(ROCS)后30 d存活的影响因素。方法采用回顾性队列研究方法,收集2013年1月至2020年9月宁夏回族自治区人民医院收治的院内及院外CA并接受CPR的538例患者的临床资料。收集患者的性别、年龄、基础疾病、CA病因、CA类型、初始心律、是否气管插管、是否除颤、是否使用肾上腺素及30 d存活率等信息。比较不同年龄段患者的CA病因及30 d存活率,以及ROSC后30 d存活与死亡患者的临床资料;采用多因素Logistic回归法分析影响患者30 d存活率的相关因素。结果538例CA-CPR患者中,排除信息不全者67例,最终471例患者纳入分析。471例患者中,男性299例,女性172例;年龄0~96岁,其中<18岁23例(占4.9%),18~64岁205例(占43.5%),≥65岁243例(占51.6%);302例(64.1%)实现ROSC,46例(9.8%)ROSC后存活30 d以上。年龄<18岁、18~64岁和≥65岁患者30 d存活率分别为8.7%(2/23)、12.7%(26/205)、7.4%(18/243);年龄<18岁患者CA主要病因为重症肺炎(13.1%,3/23)、呼吸衰竭(13.1%,3/23)和创伤(13.1%,3/23),18~64岁患者CA主要病因为急性心肌梗死(AMI;24.9%,51/205)、呼吸衰竭(9.8%,20/205)和缺氧性脑损伤(9.8%,20/205),≥65岁患者CA主要病因为AMI(24.3%,59/243)和呼吸衰竭(13.6%,33/243)。单因素分析结果显示,CA-CPR患者30 d存活率与CA病因为AMI、初始心律为室性心动过速/心室纤颤(室速/室颤)、气管插管及使用肾上腺素有关;多因素Logistic回归分析结果显示,CA病因为AMI〔优势比(OR)=0.395,95%可信区间(95%CI)为0.194~0.808,P=0.011〕及气管插管(OR=0.423,95%CI为0.204~0.877,P=0.021)是CA-CPR患者ROSC后30 d存活的保护因素。结论CA-CPR患者30 d存活率为9.8%;CA病因为AMI的CA-CPR患者ROSC后30 d存活率较其他CA病因患者更高,且早期气管插管可改善患者预后。

Objective To investigate the survival of patients with cardiac arrest and cardiopulmonary resuscitation(CA-CPR),and to analyze the factors influencing survival at 30 days after restoration of spontaneous circulation(ROSC).Methods A retrospective cohort study was conducted.Clinical data of 538 patients with CA-CPR admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2013 to September 2020 were enrolled.The gender,age,underlying disease,cause of CA,type of CA,initial rhythm,presence or absence of endotracheal intubation,defibrillation,use of epinephrine,and 30-day survival rate of patients were collected.The etiology of CA and 30-day survival rate among patients with different ages were compared,as well as the clinical data between patients who survived and died at 30 days after ROSC were also compared.Multivariate Logistic regression was used to analyze the relevant factors affecting the 30-day survival rate of patients.Results Among 538 patients with CA-CPR,67 patients with incomplete information were excluded,and 471 patients were enrolled.Among 471 patients,299 were males and 172 were females.Aged from 0 to 96 years old,23 patients(4.9%)were<18 years old,205 patients(43.5%)were 18 to 64 years old,and 243 patients(51.6%)were≥65 years old.302 cases(64.1%)achieved ROSC,and 46 patients(9.8%)survived for more than 30 days.The 30-day survival rate of patients aged<18 years old,18-64 years old and≥65 years old was 8.7%(2/23),12.7%(26/205)and 7.4%(18/243),respectively.The main causes of CA in patients younger than 18 years were severe pneumonia(13.1%,3/23),respiratory failure(13.1%,3/23),and trauma(13.1%,3/23).The main causes were acute myocardial infarction(AMI;24.9%,51/205),respiratory failure(9.8%,20/205),and hypoxic brain injury(9.8%,20/205)in patients aged 18-64 years old,and AMI(24.3%,59/243)and respiratory failure(13.6%,33/243)in patients aged≥65 years old.Univariate analysis results revealed that the 30-day survival rate of patients with CA-CPR may be related to the the cause of CA was AMI,initial rhythm was ventricular tachycardia/ventricular fibrillation,endotracheal intubation and epinephrine.Multivariate Logistic regression analysis results showed that CA was caused by AMI[odds ratio(OR)=0.395,95%confidence interval(95%CI)was 0.194-0.808,P=0.011]and endotracheal intubation(OR=0.423,95%CI was 0.204-0.877,P=0.021)was a protective factor for 30 days of survival after ROSC in patients with CA-CPR.Conclusions The 30-day survival rate of CA-CPR patients was 9.8%.The 30-day survival rate of CA-CPR patients with AMI after ROSC is higher than that of patients with other CA causes,and early endotracheal intubation can improve the prognosis of patients.