老年人院外心脏骤停特点及预后相关因素的研究

Study on the Characteristics and Prognostic Factors of Out-of-hospital Cardiac Arrest in the Elderly

目的探讨急诊老年患者院外心脏骤停的特点及心肺复苏和自主循环恢复的相关影响因素,以优化改善相关诊疗流程,提高自主循环恢复率。方法选取2018年1月1日-2022年6月30日某院急诊接诊的老年院外心脏骤停患者133例,收集相关临床资料,将患者分为自主循环恢复组和非自主循环恢复组,采用单因素分析及logistic回归分析法,分析老年患者预警症状、早期心肺复苏、急救反应时间、早期电除颤等预后影响因素与自主循环恢复的相关性。结果老年人院外心脏骤停的自主循环恢复成功率很低(8.3%),心源性疾病(50.4%)是老年人院外心脏骤停的主要病因。与中青年相比,老年人院外心脏骤停在家中的发生率(77.4%VS 45.5%),初始为不可电击心律(89.5%VS 75.9%)、有预警症状(43.6%VS 29.5%)的比例更高(P<0.05)。老年组中自主循环恢复组和非自主循环恢复组比较,多因素logistic回归分析显示:预警症状、可除颤心律、目击者心肺复苏、急救反应时间<10分钟和院外早期除颤是老年院外心脏骤停患者自主循环恢复的独立预测因素。结论老年人院外心脏骤停的病因复杂,自主循环恢复成功率很低,应重点关注有心脏骤停预警症状的急诊老年人。目击者心肺复苏、早期呼救120及电除颤均有助于提高老年院外心脏骤停患者的自主循环恢复成功率。

Objectives This study aims to explore the relevant characteristics of out-of-hospital cardiac arrest in emergency elderly patients and the relevant influencing factors of cardiopulmonary resuscitation and autonomic circulation recovery,so as to optimize and improve the relevant diagnosis and treatment processes and improve the recovery rate of autonomic circulation.Methods A total of 133 elderly patients with out-of-hospital cardiac arrest who received emergency treatment in a hospital from January 1,2018 to June 30,2022 were selected,and relevant clinical data were collected.The patients were divided into the spontaneous circulation recovery group and the nonautonomous circulation recovery group.Single-factor analysis and logistic regression analysis were used to analyze the correlation between prognostic factors such as early warning symptoms,early cardiopulmonary resuscitation,emergency response time,and early electrical defibrillation in elderly patients and the recovery of autonomic circulation.Results The success rate of spontaneous circulation recovery in out-of-hospital cardiac arrest in the elderly was very low(8.3%),and cardiogenic disease(50.4%)was the main cause of out-of-hospital cardiac arrest in the elderly.Compared with young and middle-aged people,the incidence of out-of-hospital cardiac arrest at home in the elderly(77.4%vs.45.5%),the initial non-shockable rhythm(89.5%vs.75.9%),and the proportion of early warning symptoms(43.6%vs.29.5%)were higher(P<0.05).Compared with the recovery of the spontaneous circulation group and non-spontaneous circulation recovery group in the elderly group,multivariate logistic regression analysis showed that early warning symptoms,defibrillable rhythm,witness cardiopulmonary resuscitation,first aid response time<10 minutes and early out-of-hospital defibrillation were the independent predictors of return of spontaneous circulation in elderly out-of-hospital cardiac arrest patients.Conclusions The cause of out-of-hospital cardiac arrest in the elderly is complex,and the success rate of recovery of autonomic circulation is very low.We should focus on the emergency elderly with early-warning symptoms of cardiac arrest.Eyewitness cardiopulmonary resuscitation,early call for help 120,and electric defibrillation all help to improve the success rate of spontaneous circulation recovery in elderly patients with out-of-hospital cardiac arrest.