院内心搏骤停患者自主循环恢复影响因素分析

Analysis of the influence factors of recovery of spontaneous circulation in in-hospital cardiac arrest patients

目的探讨院内心搏骤停(IHCA)患者心肺复苏后影响自主循环恢复(ROSC)的相关因素,以提高复苏的成功率。方法回顾性分析2019年11月-2020年11月期间安徽医科大学第一附属医院急诊科、重症医学科、呼吸内科等科室收治的423例IHCA患者资料。根据是否恢复自主循环分成ROSC组(109例)和复苏无效组(314例),采用单因素分析IHCA患者ROSC的影响因素,再将单因素分析中P<0.05的因素纳入二元非条件logistic回归分析。结果单因素分析结果显示,与复苏无效组比较,ROSC组包括长期居住地(城镇/农村)、心搏骤停发生季节、心电图表现早期复极综合征、严重创伤史、恶性肿瘤史、院内首诊科室、病程中有无入住ICU、院内发生心搏骤停所在科室、首次检测心律、心肺复苏期间是否实施气管插管、是否除颤、心肺复苏持续时间、是否应用肾上腺素、应用肾上腺素总剂量等多项因素,均有统计学意义(P<0.05)。Logistic回归分析示:有无入住ICU(P<0.001)、是否开放气道(P=0.007)、心肺复苏持续时间(P<0.001)、肾上腺素总剂量(P<0.001)是IHCA患者ROSC的独立影响因素。结论入住ICU、心搏骤停前已有气道开放措施、心肺复苏持续时间、肾上腺素总剂量可影响IHCA患者ROSC。

Objective To investigate the factors affecting the return of spontaneous circulation(ROSC)after cardiopulmonary resuscitation in patients with in-hospital cardiac arrest(IHCA)in order to improve the success rate of resuscitation.Methods Data of 423 IHCA patients admitted to the Emergency Department,Intensive Care Medicine Department,Respiratory Medicine Department and other departments of the First Affiliated Hospital of Anhui Medical University from November 2019 to November 2020 were retrospectively analyzed.They were divided into ROSC group(109 cases)and ineffective resuscitation group(314 cases)according to whether spontaneous circulation was restored.The influencing factors of ROSC in patients with IHCA were analyzed by univariate analysis.Then,the factors with P<0.05 in the univariate analysis were included in the binary unconditional logistic regression analysis.Results Univariate analysis showed that compared with the non-resuscitation group,the ROSC group included long-term residence(urban/rural),occurrence season of cardiac arrest,ECG manifestations of early repolarization syndrome,history of severe trauma,history of malignancy,first in-hospital department,ICU admission during the course of disease,in-hospital department of cardiac arrest,first detection of heart rhythm,whether endotracheal intubation was performed during cardiopulmonary resuscitation,whether defibrillation was performed,duration of cardiopulmonary resuscitation,whether to use epinephrine,the application of epinephrine dose and other factors,all had statistical significance(P<0.05).Logistic regression analysis showed that ICU admission(P<0.001),airway opening(P=0.007),duration of cardiopulmonary resuscitation(P<0.001)and total epinephrine dose(P<0.001)were independent factors influencing ROSC in patients with IHCA.Conclusion ICU admission,airway opening before cardiac arrest,duration of cardiopulmonary resuscitation,and total epinephrine dose can affect ROSC in patients with IHCA.