超长心肺复苏成功因素分析
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摘要
目的探讨超长心肺复苏(CPR)成功的影响因素以及适用范围。方法采用回顾性分析方法,观察2012年5月至2016年4月行超长CPR患者(CPR持续时间超过30 min)68例,分为自主循环恢复(ROSC)组32例及初级复苏失败组36例,再将ROSC组32例分为存活出院组12例及高级复苏失败组20例,分析各组患者的年龄、性别、心脏骤停至开始复苏时间、持续心肺复苏时间、电除颤开始时间、气管插管时间以及病因对复苏成功的影响。结果本研究68例患者,经超长CPR后,获ROSC 32例(47.06%);ROSC后获存活出院12例(17.65%)。ROSC组患者心脏骤停至开始CPR时间、电除颤开始时间及气管插管时间均早于初级复苏失败组(P均<0.05),年龄低于初级复苏失败组(P<0.05)。存活出院组的心脏骤停至开始CPR时间、电除颤开始时间及气管开始插管时间均早于高级复苏失败组(P均<0.05),年龄低于高级复苏失败组(P<0.05)。性别及CPR持续时间对ROSC率及存活出院率无影响(P均>0.05)。不同病因对ROSC率及存活出院率有影响(P均<0.05):68例患者行超长CPR后,获ROSC者中心脑血管病及药物中毒患者比例较高;获存活出院者中,心血管病患者比例最高。结论对于年龄<75岁,既往心肺功能良好,心脏骤停时间<10 min,特别是心肌梗死、药物中毒等病因可以在治疗中去除的患者,超长CPR建议常规进行,同时尽早行气管插管和电除颤,能有效提高患者的ROSC率及存活出院率。
Objective To explore the clinical influencing factors of successful ultra-long cardiopulmonary resuscitation( CPR) and its applicable scope. Methods A retrospective analyse was performed on 68 cases of ultra-long CPR( more than 30 min) admitted in our Emergency Department from May 2012 to April 2016. There were 32 cases in restoration of spontaneous circulation( ROSC) group in which the patients were subdivided into survival to discharge group( n = 12) and unsuccessful advanced resuscitation group( n = 20) and 36 cases in unsuccessful primary resuscitation group. The influencing factors on successful resuscitation such as age,gender,time from onset of cardiac arrest( CA) to CPR,duration of CPR,start time of defibrillation,start time of intubation and etiology were analyzed in each group. Results After the ultra-long CPR,32 cases( 47. 06%) had recovery of spontaneous circulation; and 12 patients( 17. 65%) were survival to discharge after ROSC. Some data( the time of cardiac arrest to the beginning of PCR,the start time of defibrillation and tracheal intubation) were significantly earlier in ROSC group than those in unsuccessful primary resuscitation group,and also earlier in survival to discharge group than those in unsuccessful advanced resuscitation group( all P < 0. 05),but the age was significantly younger in survival to discharge group than that in unsuccessful advanced resuscitation group( P <0. 05). Gender and cardiopulmonary resuscitation duration had no effect on ROSC rate and survival discharge rate,but the different etiology had an impact on them. The proportion of cardiovascular disease and cerebrovascular disease was higher than that of other diseases in ROSC,and the rate of survival to discharge was higher than that of other causes. Conclusions For patients of less than 75 years old,with normal cardiopulmonary functions history,CA less than 10 minutes,or with reversible reasons such as myocardial infarction,drug poisoning in the treatment,ultra-long CPR should be recommended.Moreover,defibrillation and endotracheal intubation should be performed as early as possible,which can effectively increase the rate of ROSC and discharged.
Objective To explore the clinical influencing factors of successful ultra-long cardiopulmonary resuscitation( CPR) and its applicable scope. Methods A retrospective analyse was performed on 68 cases of ultra-long CPR( more than 30 min) admitted in our Emergency Department from May 2012 to April 2016. There were 32 cases in restoration of spontaneous circulation( ROSC) group in which the patients were subdivided into survival to discharge group( n = 12) and unsuccessful advanced resuscitation group( n = 20) and 36 cases in unsuccessful primary resuscitation group. The influencing factors on successful resuscitation such as age,gender,time from onset of cardiac arrest( CA) to CPR,duration of CPR,start time of defibrillation,start time of intubation and etiology were analyzed in each group. Results After the ultra-long CPR,32 cases( 47. 06%) had recovery of spontaneous circulation; and 12 patients( 17. 65%) were survival to discharge after ROSC. Some data( the time of cardiac arrest to the beginning of PCR,the start time of defibrillation and tracheal intubation) were significantly earlier in ROSC group than those in unsuccessful primary resuscitation group,and also earlier in survival to discharge group than those in unsuccessful advanced resuscitation group( all P < 0. 05),but the age was significantly younger in survival to discharge group than that in unsuccessful advanced resuscitation group( P <0. 05). Gender and cardiopulmonary resuscitation duration had no effect on ROSC rate and survival discharge rate,but the different etiology had an impact on them. The proportion of cardiovascular disease and cerebrovascular disease was higher than that of other diseases in ROSC,and the rate of survival to discharge was higher than that of other causes. Conclusions For patients of less than 75 years old,with normal cardiopulmonary functions history,CA less than 10 minutes,or with reversible reasons such as myocardial infarction,drug poisoning in the treatment,ultra-long CPR should be recommended.Moreover,defibrillation and endotracheal intubation should be performed as early as possible,which can effectively increase the rate of ROSC and discharged.
引文
[1]Link MS,Atkins DL,Passman RS,et al.Part 6:electrical therapies:automated external defibrillators,defibrillation,cardioversion,and pacing:2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J].Circulation,2010,122(18 Suppl 3):S706-S719.
[2]彭金亮,邱军,卢加发,等.291例院外心肺复苏成功病例生存出院相关因素分析[J].中国急救复苏与灾害医学杂志,2014,9(2):108-112.
[3]杨铁城,李春盛.心肺复苏研究进展[C]//中华医学会急诊医学分会全国创伤复苏中毒学术会议,2005:188-190.
[4]朱建良,张艳,杨林,等.苏州地区心肺复苏术后早期目标治疗状况[J].中华急诊医学杂志,2013,22(10):1142-1146.
[5]陈亮,余震,梅爱红,等.经心肺复苏后自主循环恢复的心搏骤停患者预后危险因素及对策[J].中华全科医学,2017,15(7):1268-1270.
[6]Idris AH,Guffey D,Aufderheide TP,et al.Relationship between chest compression rates and outcomes from cardiac arrest[J].Circulation,2012,125(24):3004-3012.
[7]Leong SH.Mechanical CPR[J].Singapore Med J,2011,52(8):592-595.
[8]何光辉,梁彦平,宋新科,等.超长心肺复苏复苏时限的初步探讨[J].中国急救复苏与灾害医学杂志,2015,10(9):894-896.
[9]李春盛,吴彩军.心肺复苏研究的若干新进展[J].中华急诊医学杂志,2014,23(1):2-5.
[10]李雨林,张茂.美国心脏学会关于改善院内外心肺复苏预后的专家共识[J].中华急诊医学杂志,2014,23(2):143-144.
[11]洪充,吴小良,彭晓东.联合应用药物加超长时程心肺复苏的疗效分析[J].中国现代医药杂志,2013,15(11):38-40.
[12]薛继可,冷巧云,高玉芝,等.急诊科心搏骤停患者心肺复苏预后的影响因素[J].中华急诊医学杂志,2013,22(1):28-34.
[13]董燕妮,侯水珍.心搏骤停患者心肺复苏预后影响因素与护理[J].中国处方药,2014,12(10):129-130.
[14]鲁玉芬.院前心脏停搏患者心肺复苏成功的相关因素研究分析[J].中国伤残医学,2013,21(2):82-83.
[15]王立祥,黄子通.心肺复苏的误区探讨[J].临床误诊误治,2013,26(1):1-4.
[16]邢帮荣,钟新华,叶志强.超长心肺复苏成功因素分析——附1例报道[J].中国急救医学,2014,34(z1):108-110.
[2]彭金亮,邱军,卢加发,等.291例院外心肺复苏成功病例生存出院相关因素分析[J].中国急救复苏与灾害医学杂志,2014,9(2):108-112.
[3]杨铁城,李春盛.心肺复苏研究进展[C]//中华医学会急诊医学分会全国创伤复苏中毒学术会议,2005:188-190.
[4]朱建良,张艳,杨林,等.苏州地区心肺复苏术后早期目标治疗状况[J].中华急诊医学杂志,2013,22(10):1142-1146.
[5]陈亮,余震,梅爱红,等.经心肺复苏后自主循环恢复的心搏骤停患者预后危险因素及对策[J].中华全科医学,2017,15(7):1268-1270.
[6]Idris AH,Guffey D,Aufderheide TP,et al.Relationship between chest compression rates and outcomes from cardiac arrest[J].Circulation,2012,125(24):3004-3012.
[7]Leong SH.Mechanical CPR[J].Singapore Med J,2011,52(8):592-595.
[8]何光辉,梁彦平,宋新科,等.超长心肺复苏复苏时限的初步探讨[J].中国急救复苏与灾害医学杂志,2015,10(9):894-896.
[9]李春盛,吴彩军.心肺复苏研究的若干新进展[J].中华急诊医学杂志,2014,23(1):2-5.
[10]李雨林,张茂.美国心脏学会关于改善院内外心肺复苏预后的专家共识[J].中华急诊医学杂志,2014,23(2):143-144.
[11]洪充,吴小良,彭晓东.联合应用药物加超长时程心肺复苏的疗效分析[J].中国现代医药杂志,2013,15(11):38-40.
[12]薛继可,冷巧云,高玉芝,等.急诊科心搏骤停患者心肺复苏预后的影响因素[J].中华急诊医学杂志,2013,22(1):28-34.
[13]董燕妮,侯水珍.心搏骤停患者心肺复苏预后影响因素与护理[J].中国处方药,2014,12(10):129-130.
[14]鲁玉芬.院前心脏停搏患者心肺复苏成功的相关因素研究分析[J].中国伤残医学,2013,21(2):82-83.
[15]王立祥,黄子通.心肺复苏的误区探讨[J].临床误诊误治,2013,26(1):1-4.
[16]邢帮荣,钟新华,叶志强.超长心肺复苏成功因素分析——附1例报道[J].中国急救医学,2014,34(z1):108-110.