2020—2023年院前急救心肺复苏成功影响因素分析

Analysis of influencing factors of the success of pre-hospital emergency cardiopulmonary resuscitation from 2020 to 2023

目的:分析影响院外心搏骤停(OHCA)患者心肺复苏成功的影响因素,以期为提高院前心肺复苏成功率提供依据。方法:选取2020年1月至2023年12月上海市奉贤区医疗急救中心院前接诊且心肺复苏成功的OHCA病例81例进行回顾性研究,并随机选取相同时间段规范抢救30 min以上但心肺复苏失败的病例84例作为对照,对比两组患者的临床资料,采用二元logistic回归对院前心肺复苏成功影响因素进行分析。结果:单因素分析显示年龄、急救反应时间、心脑血管疾病史、目击者CPR、初始心电图类型、首剂肾上腺素时间、肾上腺素总量、通气方式是院前心肺复苏成功的影响因素(均P<0.05);二元logistic回归分析显示初始心电图类型、首剂肾上腺素时间是院前心肺复苏成功的独立影响因素(均P<0.05)。结论:初始心电图类型为非全心停搏和非无脉性心电活动是院前心肺复苏成功的有利因素;首剂肾上腺素使用时间延长,是院前心肺复苏成功的不利因素。

Objective:To analyze the influencing factors of the success of pre-hospital cardiopulmonary resuscitation(CPR)in patients with out-of-hospital cardiac arrest(OHCA),to provide the evidence for enhancing the success rate of CPR.Methods:A retrospective study was conducted on 81 cases of OHCA receiving pre-hospital treatment and successful CPR at Fengxian District Medical Emergency Center,Shanghai,from January 2020 to December 2023,and 84 cases of failed CPR after standardized rescue for over 30 minutes during the same period were randomly selected as the controls.Clinical data between these two groups were compared,and binary logistic regression was used to analyze factors affecting the success of pre-hospital CPR.Results:Single factor analysis showed that age,first aid response time,history of cardiovascular and cerebrovascular diseases,Witness CPR,the initial ECG type,the first dose of adrenaline time,the total amount of adrenaline and the way of ventilation method were related to the success of CPR(all P<0.05).Binary logistic regression analysis showed that the initial ECG type and the first dose of adrenaline time were independent influencing factors of success of CPR(all P<0.05).Conclusion:The initial electrocardiogram types of non-total cardiac arrest and non-pulseless electrical activity are favorable factor for pre-hospital CPR success;prolonged administration of the initial epinephrine dose is an adverse factor that impacts the effectiveness of pre-hospital CPR.