院外心脏骤停患者心肺复苏的现状及影响因素分析

Analysis of the situation and influencing factors of cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients

目的 分析海口市院外心脏骤停(OHCA)患者心肺复苏(CPR)效果的现状,探索提高CPR成功率的方法。方法 选取海口市2019年8月-2022年8月在院外实施CPR抢救的患者416例。基于Utstein模式比较患者院前CPR生存链的实施情况,分析影响预后的因素,通过Cox回归分析影响心脏骤停复苏有效的危险因素。结果 剔除混杂因素,416例患者中38例复苏有效(有效组),378例复苏无效(无效组),2组患者在性别、年龄、发生地、急救反应时间、初始心律类型、目击者是否执行CPR、是否予肾上腺素等方面比较,差异有统计学意义(P<0.05),多因素logistic回归分析结果显示,急救反应时间(OR:0.750,95%CI:0.640~0.891,P<0.001),目击者是否执行CPR(OR:0.063,95%CI:0.006~0.648,P=0.02)、初始心律类型(OR:0.105,95%CI:0.024~0.449,P=0.002)是院外心脏骤停患者CPR有效的独立影响因素。Cox回归分析结果显示,急救反应时间是影响复苏有效的危险因素,急救反应时间越长,患者生存率越低且风险指数越大。结论 急救反应时间、目击者是否执行CPR和初始心律类型是影响OHCA CPR有效的独立影响因素。OHCA停在流行病学上形成了一定的区域特点,院前复苏成功率的提高有赖于进一步完善院外生存链的各个关键环节,构筑全民急救体系。

Objective To analyze the current status of cardiopulmonary resuscitation(CPR)in patients with out-of-hospital cardiac arrest(OHCA)in Haikou,and to explore ways to improve the success rate of the effectiveness of CPR.Methods a total of 416 patients who underwent CPR outside the hospital in Haikou city from August 2019 to August 2022 were selected.Based on the Utstein model,the implementation of pre-hospital CPR chain of survival was compared,the factors affecting prognosis were analyzed,and the risk factors affecting the effectiveness of cardiac arrest resuscitation were analyzed by Cox regression.Results After excluding the confounding factors,a total of 416 subjects were finally included in this study,of which 38 patients were effectively resuscitated and 378 patients were ineffectively resuscitated.There was a statistically significant difference in gender,age,place of occurrence,emergency response time,initial heart rhythm type,whether witnesses CPR,and whether epinephrine was given or not between 2 groups(P<0.05).Multivariate logistic regression analysis showed that the first aid response time(OR=0.750,95%CI was 0.640~0.891,P<0.001),witnessed CPR(OR=0.063,95%CI was 0.006~0.648,P=0.02),initial rhythm type(OR=0.105,95%CI was 0.024~0.449,P=0.002)were independent influencing factors for the effectiveness of CPR in patients with out-of-hospital cardiac arrest.The results of Cox regression analysis showed that emergency response time was a risk factor of affecting effective resuscitation,and the longer the emergency response time was,the lower the patient survival rate and the greater the risk index.Conclusion Emergency response time,witness CPR,and initial heart rhythm type are independent factors of affecting the effectiveness of CPR in OHCA patients.OHCA has formed certain regional characteristics in epidemiology,and the improvement of the success rate of pre-hospital resuscitation depends on further improving each key link of the out-of-hospital survival chain and building a national first aid system.