基于Utstein模式下秦皇岛地区院前心搏骤停患者生存链现状分析
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摘要
目的:分析秦皇岛地区院前心搏骤停患者(CA)心肺复苏"生存链"实施现状,探索我国实际情况下如何提高院前心肺复苏成功率。方法:基于Utstein模式,收集2015-02-2017-09期间秦皇岛市第一医院急诊科、秦皇岛市海港医院急诊科、秦皇岛市中医医院急诊科、北戴河医院急诊科接诊的187例院前CA患者,分为复苏有效组和复苏无效组。比较两组患者院前心肺复苏(CPR)生存链的实施情况,分析影响预后的因素。结果:本研究共纳入187例CA患者,男131例(70%),女56例(30%);平均年龄(63.30±16.12)岁,复苏成功率为32.08%。院前CA发生在住所(54.5%)、公共场所(26.7%)。院前CA原因主要为心源性疾病(40.6%),其次为创伤(24.1%)。78.6%的CA有目击者,但只有12.8%由目击者进行了现场CPR。14.4%的CA给予院前除颤,而院前气管插管率仅为11.2%。与复苏无效组比较,复苏有效组在目击者CPR(χ~2=23.270,P=0.000)、CA至专业CPR<5min(χ~2=27.770,P=0.000)、院前除颤(χ~2=4.459,P=0.035)、院前气管插管(χ~2=5.807,P=0.016)、院前肾上腺素使用(χ~2=7.039,P=0.008),差异有统计学意义。结论:秦皇岛地区院前CA的复苏成功率不高,院前"生存链"中很多因素有待进一步完善。
Objective:To evaluate the status of"the chain of survival"of cardiopulmonary resuscitation in patients with cardiac arrest in Qinhuangdao area,Improve the Success Rate of Pre-hospital Cardiopulmonary Resuscitation in Our Country.Method:Based on the Utstein model,187 cases of pre-hospital CA patients receiving Emergency Department of Qinhuangdao First Hospital,Emergency Department of Qinhuangdao Haigang Hospital,Emergency Department of Qinhuangdao Hospital of Traditional Chinese Medicine and Emergency Department of Beidaihe Hospital from February 2015 to September 2017 were divided into recovery effective group And recovery invalid group.Compare the implementation status of pre-hospital CPR survival between the two groups,and analyze the factors affecting the prognosis.Result:A total of 187 CA patients were enrolled in this study,including 131 males(70%)and 56 females(30%)with a mean age of(63.30±16.12)years and a successful rate of 32.08%.Prehospital CA occurred at home(54.5%)and public places(26.7%).The main causes of prehospital CA were cardiogenic disease(40.6%),followed by trauma(24.1%).There were eye witnesses in 78.6% of CA,but only12.8% of them were witness on-site CPR.Pretreatment defibrillation was given in 14.4% of CA,while the rate of intubation intubation was only 11.2%.Compared with the resuscitation ineffective group,the effective resuscitation group showed significant differences in the number of eyewitnesses CPR(χ~2=23.270,P=0.000),CA to professional CPR<5 min(χ~2=27.770,P=0.000)Pre-anterior defibrillation(χ~2=4.459,P=0.035),pre-hospital tracheal intubation(χ~2=5.807,P =0.016),prehospital epinephrine use(χ~2=7.039,P =0.008),the difference was statistically significant.Conclusion:The success rate of pre-hospital CA recovery in Qinhuangdao is not high,and many factors in Pre-hospital"chain of survival"need to be further improved.
Objective:To evaluate the status of"the chain of survival"of cardiopulmonary resuscitation in patients with cardiac arrest in Qinhuangdao area,Improve the Success Rate of Pre-hospital Cardiopulmonary Resuscitation in Our Country.Method:Based on the Utstein model,187 cases of pre-hospital CA patients receiving Emergency Department of Qinhuangdao First Hospital,Emergency Department of Qinhuangdao Haigang Hospital,Emergency Department of Qinhuangdao Hospital of Traditional Chinese Medicine and Emergency Department of Beidaihe Hospital from February 2015 to September 2017 were divided into recovery effective group And recovery invalid group.Compare the implementation status of pre-hospital CPR survival between the two groups,and analyze the factors affecting the prognosis.Result:A total of 187 CA patients were enrolled in this study,including 131 males(70%)and 56 females(30%)with a mean age of(63.30±16.12)years and a successful rate of 32.08%.Prehospital CA occurred at home(54.5%)and public places(26.7%).The main causes of prehospital CA were cardiogenic disease(40.6%),followed by trauma(24.1%).There were eye witnesses in 78.6% of CA,but only12.8% of them were witness on-site CPR.Pretreatment defibrillation was given in 14.4% of CA,while the rate of intubation intubation was only 11.2%.Compared with the resuscitation ineffective group,the effective resuscitation group showed significant differences in the number of eyewitnesses CPR(χ~2=23.270,P=0.000),CA to professional CPR<5 min(χ~2=27.770,P=0.000)Pre-anterior defibrillation(χ~2=4.459,P=0.035),pre-hospital tracheal intubation(χ~2=5.807,P =0.016),prehospital epinephrine use(χ~2=7.039,P =0.008),the difference was statistically significant.Conclusion:The success rate of pre-hospital CA recovery in Qinhuangdao is not high,and many factors in Pre-hospital"chain of survival"need to be further improved.
引文
[1]王立祥,孟庆义,余涛.2016中国心肺复苏专家共识[J].中华危重病急救医学,2016,28(12):1059-1079.
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[10]涂建锋,蔡文伟,杨悦,等.浙江省居民院前急救现状与需求[J].中华急诊医学杂志,2013,22(6):673-676.
[11]景建军,何光辉,俞作发.实施心肺复苏后临床预后及危险因素分析[J].临床急诊杂志,2017,18(6):428-432.
[12]单爱军,王进,杜波等.深圳市心源性猝死院前急救的调查分析[J].中国急救医学,2014,(S1):79-83.
[13]李博,李莉,娄小平,等.社区居民中开展心肺复苏知识技能培训效果评价[J].临床急诊杂志,2015,16(9):716-719.
[14]Yang H J,Woon K G,Hyun K,et al.Epidemiology and outcomes in out-of-hospital cardiac arrest:a report from the NEDIS-based cardiac arrest registry in Korea[J].J Korean Med Sci,2015,30:95-103.
[15]Fukuda T,Ohashi-Fukuda N,Matsubara T,et al.Effect of prehospital epinephrine on out-of-hospital cardiac arrest:a report from the national out-of-hospital cardiac arrest data registry in Japan,2011-2012[J].Eur J Clin Pharmacol,2016,72:1255-1264.
[16]樊麦英,邹联洪,刘晓亮,等.湖南地区第一目击者——现场急救知识需求和意愿分析[J].临床急诊杂志,2016,17(8):606-609.
[2]Hazinski M F,Field J M.2010American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science[J].Circulation,2010,122:S639-S946.
[3]李华,张劲松,陈彦.院前心脏停搏与院内心脏停搏复苏存活率的比较[J].临床急诊杂志,2013,14(12):599-601.
[4]魏捷,胡念丹.《2015年美国心脏协会心肺复苏及心血管急救指南更新》解读之急救系统和持续质量改进[J].临床急诊杂志,2016,17(1):1-3.
[5]Billi J E,Zideman D A,Eigel B,et al.Conflict of interest management before,during,and after the 2005International Consensus Conference on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J].Resuscitation,2005,67:171-173.
[6]李庆春,彭昭群,何琦,等.重庆西南铝医院院前急救现状分析[J].临床急诊杂志,2017,18(2):145-147.
[7]El Sayed M J,Tamim H,Nasreddine Z,et al.Out-ofhospital cardiac arrest survival in Beirut,Lebanon[J].Eur J Emerg Med,2014,21:281-283.
[8]朱建良,刘励军,Phillips Sauder.苏州与法国斯特拉斯堡院外心搏骤停患者生存链质量比较[J].中国急救医学,2015,35(2):142-146.
[9]Neumar R W,Shuster M,Callaway C W,et al.Part 1:Executive Summary:2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J].Circulation,2015,132:S315-367.
[10]涂建锋,蔡文伟,杨悦,等.浙江省居民院前急救现状与需求[J].中华急诊医学杂志,2013,22(6):673-676.
[11]景建军,何光辉,俞作发.实施心肺复苏后临床预后及危险因素分析[J].临床急诊杂志,2017,18(6):428-432.
[12]单爱军,王进,杜波等.深圳市心源性猝死院前急救的调查分析[J].中国急救医学,2014,(S1):79-83.
[13]李博,李莉,娄小平,等.社区居民中开展心肺复苏知识技能培训效果评价[J].临床急诊杂志,2015,16(9):716-719.
[14]Yang H J,Woon K G,Hyun K,et al.Epidemiology and outcomes in out-of-hospital cardiac arrest:a report from the NEDIS-based cardiac arrest registry in Korea[J].J Korean Med Sci,2015,30:95-103.
[15]Fukuda T,Ohashi-Fukuda N,Matsubara T,et al.Effect of prehospital epinephrine on out-of-hospital cardiac arrest:a report from the national out-of-hospital cardiac arrest data registry in Japan,2011-2012[J].Eur J Clin Pharmacol,2016,72:1255-1264.
[16]樊麦英,邹联洪,刘晓亮,等.湖南地区第一目击者——现场急救知识需求和意愿分析[J].临床急诊杂志,2016,17(8):606-609.