基于Utstein心源性和非心源性院外心脏骤停患者临床特征对比研究

Comparative study on clinical characteristics of cardiogenic and non-cardiogenic cardiac arrest patients out-of-hospital based on Utstein style

目的分析院外心脏骤停(out-of-hospital cardiac arrest,OHCA)患者发病原因和不同病因下院前急救措施和复苏结局的差异,提高其抢救成功率。方法回顾性收集2021年1月至2021年12月北京急救中心接诊的所有OHCA患者资料,包括院前急救病历及医疗机构内抢救结果。比较心源性和非心源性心脏骤停患者的基本情况,采用非参数检验和卡方分析方法比较不同组别患者抢救措施和复苏结果的差异。结果本研究共纳入7517例患者,心源性心脏骤停患者年龄较大,多伴有基础疾病(84.2%),且在家中发病为主。非心源性心脏骤停的原因包括疾病(85.1%)、创伤(2.9%)、自杀(5.0%)、交通事故(1.7%)及中毒(1.1%)等。在急救措施方面,急救医生到达现场后,对心源性患者采取抢救措施的比例较高(22.3%),包括心肺复苏、气管插管、除颤、吸氧、注射肾上腺素和使用其他药物均显著高于非心源性患者(均P<0.001)。在临床结局方面,心源性与非心源性患者自主循环恢复(P=0.072)和24 h存活(P=0.093)则差异无统计学意义。结论心源性心脏骤停是OHCA的主要原因,多伴有基础疾病,且年龄较大,以家中发病为主要临床特征,应继续加强院前急救心脏骤停综合救治措施,以提高OHCA抢救成功率。

Objective To analyze the causes of out-of-hospital cardiac arrest(OHCA)and the differences in outcomes of pre-hospital first-aid measures and cardiopulmonary resuscitation for different etiologies,improved the success rate of rescue.Methods A retrospective study was conducted on OHCA patients admitted to Beijing Emergency Medical Centre from January to December 2021.The pre-hospital emergency medical records and rescue results within medical institutions were collected.Compared the basic situation between patients with cardiogenic and non-cardiogenic cardiac arrest,the differences of rescue measures and CPR outcomes between the groups were compared by non-parametric test andχ2 test.Results A total of 7517 patients were included in this study.Cardiogenic arrest patients were older,more underlying diseases(84.2%),and cardiac arrest mainly occurred at home.The cause of non-cardiogenic arrest included disease(85.1%),trauma(2.9%),suicide(5.0%),traffic accidents(1.7%),poisoning(1.1%),and so on.In terms of first-aid measures,after the emergency doctor arrived at the scene,the proportion of first-aid measures used for cardiogenic patients was high(22.3%),and the first aid measures include cardiopulmonary resuscitation,tracheal intubation,defibrillation,oxygen inhalation,injection of adrenaline and use of other drugs.All the proportions of first-aid measures for cardiogenic patients were significantly higher than non-cardiogenic patients(all P<0.001).In terms of clinical outcomes,there were no statistical differences in return of spontaneous circulation(P=0.072)and 24-hour survival(P=0.093)between cardiogenic and non-cardiogenic patients.Conclusions Cardiogenic cardiac arrest was the main cause of OHCA.Cardiogenic arrest patients were more underlying diseases,and older in age,the main clinical feature was onset at home.The comprehensive treatment measures for pre-hospital first-aid cardiac arrest should continue to be strengthened to improve the success rate of rescue for OHCA.