初始节律对院内心搏骤停患者出院存活的影响
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摘要
目的评估初始节律对院内心搏骤停(IHCA)心肺复苏(CPR)出院存活的影响。方法采用标准的心肺复苏Utstein模式注册登记表收集我院2010年1月~2017年12月发生的IHCA患者59例,根据患者心脏骤停(CA)时监测到的心律分为可除颤心律组[室颤(VF)、无脉性室性心动过速(VT)]和不可除颤性心律组[无脉性心电活动(PEA)、心电静止(ASY)],利用χ2检验比较不同分组及不同亚组间自发循环恢复(ROSC)率及出院存活率。结果 59例IHCA并行CPR患者中,28例初始节律为可除颤心律,其中VF 27例(45.8%),VT 1例(1.7%),31例不可除颤心律中PEA 14例(23.7%),ASY 17例(28.8%),可除颤心律自主循环恢复、出院存活分别为25例(89.3%)、22例(78.6%),不可除颤心律ROSC及出院存活分别为11例(35.5%)、3例(9.7%)。χ2检验显示:可除颤心律是影响出院存活的预测因素,但可除颤心律组及不可除颤心律的亚组之间比较差异无明显统计学意义(P>0.05)。结论初始节律为可除颤心律是预测出院存活的指标,但不同亚组间对出院存活预后无明显影响。
Objective To evaluate the influence of the first documented rhythm on patients survived to discharge with in-hospital cardiac arrest.Methods The clinical data of 59 in-hospital cardiac arrest patients collected from Jan 2010 to Dec 2017 were reviewed.The patients were divided into defibrillative rhythm group [ventricular fibrillation(VF)/ventricular tachyeardia(VT)] and non defibrillative rhythm group[pulseless electrical activity(PEA)/asystole(ASY)] according to the first documented rhythm after cardiac arrest.The differences in rate of restoration of spontaneous circulation(ROSC),number of survival at hospital discharge were compared between groups.Chi-square test was performed between two groups and subgroups.Results Of 59 indexed cardiac arrests,first documented pulseless rhythm was ventricular fibrillation(VF) in 27(45.8%),ventricular tachyeardia(VT) in 1(1.7%),pulseless electrical activity(PEA) in 14(23.7%)and asystole in 17(28.8%).Of 28 defibrillative rhythm patients,25(89.3%) had ROSC,22(78.6%) survived to discharge.Of 31 non defibrillative rhythm patients,11(35.5%) had ROSC,3(9.7%) survived to discharge.Chi-square test showed that defibrillative rhythm was related to high of ROSC rate of survived to discharge,numbers of survival at hospital discharge were higher in the defibrillative rhythm group,while there was no diference in outcomes between the VF and VT groups.There was no difference between the PEA and asystole groups.Conclusion Rate of survival at hospital discharge is higher with defibrillative initial rhythm,no difference is found between subgroups.
Objective To evaluate the influence of the first documented rhythm on patients survived to discharge with in-hospital cardiac arrest.Methods The clinical data of 59 in-hospital cardiac arrest patients collected from Jan 2010 to Dec 2017 were reviewed.The patients were divided into defibrillative rhythm group [ventricular fibrillation(VF)/ventricular tachyeardia(VT)] and non defibrillative rhythm group[pulseless electrical activity(PEA)/asystole(ASY)] according to the first documented rhythm after cardiac arrest.The differences in rate of restoration of spontaneous circulation(ROSC),number of survival at hospital discharge were compared between groups.Chi-square test was performed between two groups and subgroups.Results Of 59 indexed cardiac arrests,first documented pulseless rhythm was ventricular fibrillation(VF) in 27(45.8%),ventricular tachyeardia(VT) in 1(1.7%),pulseless electrical activity(PEA) in 14(23.7%)and asystole in 17(28.8%).Of 28 defibrillative rhythm patients,25(89.3%) had ROSC,22(78.6%) survived to discharge.Of 31 non defibrillative rhythm patients,11(35.5%) had ROSC,3(9.7%) survived to discharge.Chi-square test showed that defibrillative rhythm was related to high of ROSC rate of survived to discharge,numbers of survival at hospital discharge were higher in the defibrillative rhythm group,while there was no diference in outcomes between the VF and VT groups.There was no difference between the PEA and asystole groups.Conclusion Rate of survival at hospital discharge is higher with defibrillative initial rhythm,no difference is found between subgroups.
引文
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8 赵梦龙,郭凯,马永刚,等.心搏骤停患者初始节律影响因素分析[J].中国全科医学,2017,20(4):79-82
9 黎敏,宋维,吕雪,等.心肺复苏Utstein模式注册登记研究:急性心肌梗死导致心脏骤停的流行病学调查研究[J].中华急诊医学杂志,2014,12(23):1385-1388
10 Pirrallo RG,Aufderheide TP,Provo TA,et al.Effect of an inspiratory impedance threshod device on hemodynamics during conventional manual cardiopulmonary resuscitation[J].Resuscitation,2005,66:13-20
2 薛继可,冷巧云,高玉枝,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
3 Meaney PA,Nadkarni VM,Kern KB,et al.Rhythms and outcomes of adult in-hospital cardiac arrest[J].Crit Care Med,2010,38(1):101-108
4 钱欣,林世荣.初始心律对院内心搏骤停患者预后的影响[J].中华急诊医学杂志,2017,26(2):202-205
5 Keller SP,Halperin HR.Cm'diac arrest:the changing incidence of ventricular fibrillation[J].Crux Treat Options Cardiurasc Med,2015,17(7):392
6 Cuba V,Jaehae AK,Suarez A,et al.The incidence and significance of bacteremia in out of hospital cardiac arrest[J].Resuscitation,2014,85(2):196-202
7 Moller SG,Rajain S,Folke F,et al.Temporal trends insurvival after out-of-hospital cardiac arrest in patients with and without underlying chronic obstructive pulmonary disease[J].Resuscitation,2016,104:76-82
8 赵梦龙,郭凯,马永刚,等.心搏骤停患者初始节律影响因素分析[J].中国全科医学,2017,20(4):79-82
9 黎敏,宋维,吕雪,等.心肺复苏Utstein模式注册登记研究:急性心肌梗死导致心脏骤停的流行病学调查研究[J].中华急诊医学杂志,2014,12(23):1385-1388
10 Pirrallo RG,Aufderheide TP,Provo TA,et al.Effect of an inspiratory impedance threshod device on hemodynamics during conventional manual cardiopulmonary resuscitation[J].Resuscitation,2005,66:13-20