院内心搏骤停患者自主循环恢复影响因素分析

梁顺达; 方芳; 丁智颖; 李星星; 何苗; 黄嘉琳; 张泓

doi:10.16766/j.cnki.issn.1674-4152.003107

院内心搏骤停患者自主循环恢复影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003107

1.
安徽医科大学第一附属医院全科，安徽合肥 230000
2.
安徽医科大学第一附属医院急诊科

基金项目:

安徽省卫生健康软科学研究项目 2020WR02003

详细信息

通讯作者:
张泓，E-mail：zhanghong20070703@163.com

中图分类号: R541.78
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- 文章访问数: 414
- HTML全文浏览量: 167
- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-15
- 网络出版日期: 2023-09-13

Analysis of the influence factors of recovery of spontaneous circulation in in-hospital cardiac arrest patients

1.
Department of General Practice, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, China

摘要

摘要: 目的探讨院内心搏骤停(IHCA)患者心肺复苏后影响自主循环恢复(ROSC)的相关因素，以提高复苏的成功率。方法回顾性分析2019年11月—2020年11月期间安徽医科大学第一附属医院急诊科、重症医学科、呼吸内科等科室收治的423例IHCA患者资料。根据是否恢复自主循环分成ROSC组(109例)和复苏无效组(314例)，采用单因素分析IHCA患者ROSC的影响因素，再将单因素分析中P＜0.05的因素纳入二元非条件logistic回归分析。结果单因素分析结果显示，与复苏无效组比较，ROSC组包括长期居住地(城镇/农村)、心搏骤停发生季节、心电图表现早期复极综合征、严重创伤史、恶性肿瘤史、院内首诊科室、病程中有无入住ICU、院内发生心搏骤停所在科室、首次检测心律、心肺复苏期间是否实施气管插管、是否除颤、心肺复苏持续时间、是否应用肾上腺素、应用肾上腺素总剂量等多项因素，均有统计学意义(P < 0.05)。Logistic回归分析示：有无入住ICU(P < 0.001)、是否开放气道(P=0.007)、心肺复苏持续时间(P < 0.001)、肾上腺素总剂量(P < 0.001)是IHCA患者ROSC的独立影响因素。结论入住ICU、心搏骤停前已有气道开放措施、心肺复苏持续时间、肾上腺素总剂量可影响IHCA患者ROSC。
- 院内心搏骤停 /
- 心肺复苏 /
- 自主循环恢复 /
- 影响因素
Abstract: Objective To investigate the factors affecting the return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation in patients with in-hospital cardiac arrest (IHCA) in order to improve the success rate of resuscitation. Methods Data of 423 IHCA patients admitted to the Emergency Department, Intensive Care Medicine Department, Respiratory Medicine Department and other departments of the First Affiliated Hospital of Anhui Medical University from November 2019 to November 2020 were retrospectively analyzed. They were divided into ROSC group (109 cases) and ineffective resuscitation group (314 cases) according to whether spontaneous circulation was restored. The influencing factors of ROSC in patients with IHCA were analyzed by univariate analysis. Then, the factors with P < 0.05 in the univariate analysis were included in the binary unconditional logistic regression analysis. Results Univariate analysis showed that compared with the non-resuscitation group, the ROSC group included long-term residence (urban/rural), occurrence season of cardiac arrest, ECG manifestations of early repolarization syndrome, history of severe trauma, history of malignancy, first in-hospital department, ICU admission during the course of disease, in-hospital department of cardiac arrest, first detection of heart rhythm, whether endotracheal intubation was performed during cardiopulmonary resuscitation, whether defibrillation was performed, duration of cardiopulmonary resuscitation, whether to use epinephrine, the application of epinephrine dose and other factors, all had statistical significance (P < 0.05). Logistic regression analysis showed that ICU admission (P < 0.001), airway opening (P=0.007), duration of cardiopulmonary resuscitation (P < 0.001) and total epinephrine dose (P < 0.001) were independent factors influencing ROSC in patients with IHCA. Conclusion ICU admission, airway opening before cardiac arrest, duration of cardiopulmonary resuscitation, and total epinephrine dose can affect ROSC in patients with IHCA.
- In-hospital cardiac arrest /
- Cardiopulmonary resuscitation /
- Return of spontaneous circulation /
- Influence factors

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图 1 入选院内心搏骤停病例及其总体复苏预后

注：CPR为心肺复苏(cardiopulmonary resuscitation)。

Figure 1. The selected IHCA cases and their overall resuscitation outcomes

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表 1 自主循环恢复组和复苏无效组患者一般资料比较(例)

Table 1. Comparison of the general data of patients in the ROSC group and the ineffective resuscitation group(cases)

指标	ROSC组 (n=109)	复苏无效组 (n=314)	统计量	P值	指标	ROSC组 (n=109)	复苏无效组 (n=314)	统计量	P值
性别			0.704^a	0.401	既往心电图是否存在早期复极综合征			7.404^a	0.025
男性	67	207			是	49	99
女性	42	107			否	45	146
年龄			-0.013^b	0.989	不详	15	69
18~59岁	37	107			既往心电图是否存在QT间期延长			5.581^a	0.061
60~79岁	55	134			是	26	50
≥80岁	17	73			否	68	195
长期居住地			8.028^a	0.005	不详	15	69
城镇	45	179			吸烟史			3.265^a	0.071
农村	64	135			不吸烟	83	210
长期省内居住区域			3.705^a	0.157	吸烟	26	104
皖南	4	22			饮酒史			2.495^a	0.114
皖中	75	229			不饮酒	84	217
皖北	30	63			饮酒	25	97
注：^a为χ²值，^b为Z值。

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表 2 自主循环恢复组和复苏无效组患者基础病特点比较(例)

Table 2. Comparison of the characteristics of basic diseases in patients with ROSC group and ineffective resuscitation group(cases)

指标	ROSC组(n=109)	复苏无效组(n=314)	χ²值	P值	指标	ROSC组(n=109)	复苏无效组(n=314)	χ²值	P值
冠心病(此次入院主因)			0.004	0.948	糖尿病(此次入院)			0.102	0.750
无	94	270			无	87	255
有	15	44			有	22	59
高血压病史			0.394	0.530	脓毒症(此次住院)			1.508	0.219
无	70	191			无	99	271
有	39	123			有	10	43
心律失常史			0.803	0.370	严重创伤(此次住院)			5.852	0.016
无	79	241			无	95	298
有	30	73			有	14	18
呼吸衰竭(此次入院)			0.133	0.716	恶性肿瘤(此次住院)			4.895	0.027
无	68	202			无	91	229
有	41	112			有	18	85
酸碱平衡/电解质紊乱(此次入院)			0.050	0.824
无	40	119
有	69	195

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表 3 自主循环恢复组和复苏无效组患者诊治相关资料比较(例)

Table 3. Comparison of diagnosis and treatment data between patients with ROSC group and ineffective resuscitation group(cases)

指标	ROSC组(n=109)	复苏无效组(n=314)	χ²值	P值	指标	ROSC组(n=109)	复苏无效组(n=314)	χ²值	P值
院内心搏骤停发生时间			1.009	0.315	病程中有无入住ICU			40.395	< 0.001
昼(8:00 a.m.—7.59 p.m.)	63	164			有	85	134
夜(8:00 p.m.—7.59 a.m.)	46	150			无	24	180
院内心搏骤停发生季节			9.411	0.024	院内发生心搏骤停所在科室			17.950	0.001
春(农历1—3月)	22	99			内科	24	124
夏(农历4—6月)	29	62			外科	25	43
秋(农历7—9月)	11	49			急诊	4	10
冬(农历10—12月)	47	104			重症	52	109
心搏骤停首发症状			0.411	0.522	其他	4	28
有前驱症状(胸痛、胸闷、意识障碍等)	42	132			心脏骤停病因			0.221	0.638
无前驱症状	67	182			心源性	52	158
院内首诊科室			10.056	0.018	非心源性	57	156
内科	24	94			首次监测心律			9.843	0.002
外科	25	46			可除颤心律(室颤、无脉室速)	23	30
急诊	58	150			不可除颤心律(心室停搏PEA)	86	284
其他	2	24

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表 4 自主循环恢复组和复苏无效组患者复苏相关资料比较(例)

Table 4. Comparison of resuscitation data in patients with ROSC group and ineffective resuscitation group(cases)

指标	ROSC组 (n=109)	复苏无效组 (n=314)	χ²值	P值
心搏骤停后仅胸外按压			0.741	0.389
是	7	12
否	102	302
心肺复苏持续时间			54.700	< 0.001
≤30 min	77	95
＞30 min	32	219
心肺复苏期间是否实施气管插管			9.555	0.008
是	49	94
否	30	130
已有开放气道措施	30	90
心肺复苏期间是否实施除颤			7.995	0.005
是	33	55
否	76	259
心肺复苏期间是否应用肾上腺素			9.468	0.002
是	92	295
否	17	19
心肺复苏期间应用肾上腺素总剂量			19.789	< 0.001
≤5 mg	86	172
>5 mg	23	142

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表 5 变量赋值方法

Table 5. Variable assignment method

变量	赋值方法
长期居住地	城镇=1；农村=2
既往心电图是否存在早期复极综合征	是=1；否=2
心搏骤停发生季节	春天=(0，0，0)；夏天=(1，0，0)；秋天=(0，1，0)；冬天=(0，0，1)
心搏骤停前有恶性肿瘤史	无=1；有=2
院内首诊科室	内科=(0，0，0)；外科=(1，0，0)；急诊科=(0，1，0)；其他科室=(0，0，1)
病程中有无入住ICU	有=1；无=2
院内发生CA时所在科室	内科=(0，0，0)；外科=(1，0，0)；急诊科=(0，1，0)；其他科室=(0，0，1)
CA后首次监测心律	可除颤心律=1；不可除颤心律=2
心肺复苏持续时间	≤30 min=1；＞30 min=2
心肺复苏期间是否实施气管插管	是=(0，0)；否=(1，0)；已有气道保护措施=(0，1)
心肺复苏期间是否实施除颤	是=1；否=2
心腹复苏期间是否使用肾上腺素	是=1；否=2
使用肾上腺素总剂量	≤5 mg=1；＞5 mg=2

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表 6 院内心搏骤停患者自主循环恢复多因素logistic回归分析

Table 6. Multivariate logistic regression analysis of ROSC in patients with cardiac arrest in hospital

变量	B	SE	Wald χ²	P值	OR值	95% CI
居住在农村	0.612	0.347	3.015	0.078	1.845	0.934~3.645
既往心电图不存在早期复极	-0.513	0.356	2.074	0.150	0.599	0.298~1.203
CA发生在夏天	0.781	0.445	3.075	0.079	2.183	0.912~5.224
CA发生在秋天	0.248	0.575	0.185	0.667	1.281	0.415~3.956
CA发生在冬天	0.797	0.420	3.605	0.058	2.218	0.975~5.047
肿瘤史	0.108	0.412	0.068	0.794	1.114	0.496~2.500
首诊科室在外科	-0.429	0.580	0.547	0.460	0.651	0.209~2.031
首诊科室在急诊	0.038	0.433	0.008	0.929	1.039	0.445~2.428
首诊科室在其他科室	-1.170	1.218	0.923	0.337	0.310	0.029~3.378
入住ICU	-2.795	0.492	32.289	< 0.001	0.061	0.023~0.160
CA发生在外科	0.832	0.614	1.836	0.175	2.298	0.690~7.660
CA发生在急诊科	1.294	0.868	2.224	0.136	3.648	0.666~19.984
CA发生在重症	0.003	0.551	0.000	0.996	1.003	0.341~2.954
CA发生在其他科室	0.352	0.882	0.159	0.690	1.422	0.252~8.017
首次检测到为不可除颤心律	-0.611	0.517	1.396	0.237	0.543	0.197~1.459
心肺复苏持续时间≤30 min	-1.635	0.344	22.529	< 0.001	0.195	0.099~0.383
未实施气管插管	-0.775	0.410	3.579	0.059	0.461	0.206~1.028
已有气道开放措施	-1.179	0.434	7.385	0.007	0.308	0.131~0.720
未实施除颤	-0.461	0.435	1.121	0.290	0.631	0.269~1.480
未应用肾上腺素	0.333	0.595	0.313	0.576	1.395	0.434~4.479
肾上腺素总剂量≤5 mg	-1.664	0.388	18.389	< 0.001	0.189	0.089~0.405

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参考文献(20)

[1]	王立祥, 孟庆义, 余涛, 等. 2016中国心肺复苏专家共识[J]. 中华灾害救援医学, 2017, 5(1): 1-23. https://www.cnki.com.cn/Article/CJFDTOTAL-JYZH201701003.htm WANG L X, MENG Q Y, YU T, et al. 2016 National consensus on cardiopulmonary resuscitation in China[J]. Chinese Journal of Disaster Medicine, 2017, 5(1): 1-23. https://www.cnki.com.cn/Article/CJFDTOTAL-JYZH201701003.htm
[2]	余涛, 唐万春. 清醒、积极地面对心肺复苏指南的改变[J]. 中华急诊医学杂志, 2012, 21(1): 9-11. doi: 10.3760/cma.j.issn.1671-0282.2012.01.002 YU T, TANG W C. Be awake and positive about the changes in CPR guidelines[J]. Chinese Journal of Emergency Medicine, 2012, 21(1): 9-11. doi: 10.3760/cma.j.issn.1671-0282.2012.01.002
[3]	NOLAN J P, BERG R A, ANDERSEN L W, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry template for In-hospital cardiac arrest: a consensus report from a task force of the international liaison committee on resuscitation[J]. Circulation, 2019, 140(18): e746-e757.
[4]	HOLMBERG M J, ROSS C E, FITZMAURICE G M, et al. Annual incidence of adult and pediatric In-hospital cardiac arrest in the United States[J]. Circ Cardiovasc Qual Outcomes, 2019, 12(7): e005580. DOI: 10.1161/CIRCOUTCOMES.119.005580.
[5]	ANDERSEN L W, HOLMBERG M J, LOFGREN B, et al. Adult in-hospital cardiac arrest in Denmark[J]. Resuscitation, 2019, 140: 31-36. doi: 10.1016/j.resuscitation.2019.04.046
[6]	OHBE H, TAGAMI T, UDA K, et al. Incidence and outcomes of in-hospital cardiac arrest in Japan 2011-2017: a nationwide inpatient database study[J]. J Intensive Care, 2022, 10(1): 10. doi: 10.1186/s40560-022-00601-y
[7]	沈钦海, 秦召敏, 孔瑞雪, 等. 呼吸心跳骤停患者急诊心肺复苏的影响因素[J]. 医学信息, 2022, 35(12): 143-145. https://www.cnki.com.cn/Article/CJFDTOTAL-YXXX202212034.htm SHEN Q H, QIN Z M, KONG R X, et al. Influencing Factors of Emergency Cardiopulmonary Resuscitation in Patients with Respiratory and Cardiac Arrest[J]. Medical Information, 2022, 35(12): 143-145. https://www.cnki.com.cn/Article/CJFDTOTAL-YXXX202212034.htm
[8]	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. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.053 CHEN L, YU Z, MEI A H, et al. Cardiac arrest patients with spontaneous circulatory recovery after cardiopulmonary resuscitation Prognostic risk factors and countermeasures[J]. Chinese Journal of General Practice, 2017, 15(7): 1268-1270. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.053
[9]	SHAO F, LI C S, LIANG L R, et al. Incidence and outcome of adult in-hospital cardiac arrest in Beijing, China[J]. Resuscitation, 2016, 102: 51-56. doi: 10.1016/j.resuscitation.2016.02.002
[10]	BENJAMIN E J, VIRANI S S, CALLAWAY C W, et al. American heart association council on epidemiology and prevention statistics committee and stroke statistics subcommittee. Heart disease and stroke statistics-2018 update: a report from the american heart association[J]. Circulation, 2018, 137(12): e67-e492.
[11]	WANG C, ZHENG W, ZHENG J, et al. A national effort to improve outcomes for in-hospital cardiac arrest in China: the BASeline Investigation of cardiac arrest(BASIC-IHCA)[J]. Resusc Plus, 2022, 11: 100259. DOI: 10.1016/j.resplu.2022.100259.
[12]	ANDERSEN L W, HOLMBERG M J, BERG K M, et al. In-hospital cardiac arrest: a review[J]. JAMA, 2019, 321(12): 1200-1210. doi: 10.1001/jama.2019.1696
[13]	NOLAN J P, BERG R A, ANDERSEN L W, et al. Utstein collaborators. cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry template for In-hospital cardiac arrest: a consensus report from a task force of the international liaison committee on resuscitation[J]. Resuscitation, 2019, 144: 166-177.
[14]	PERMAN S M, STANTON E, SOAR J, et al. Location of In-hospital cardiac arrest in the USA-variability in event rate and outcomes[J]. J Am Heart Assoc, 2016, 5 (10): e003638. DOI: 10.1161/JAHA.116.003638.
[15]	RAZA A, ARSLAN A, ALI Z, et al. How long should we run the code? Survival analysis based on location and duration of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest[J]. J Community Hosp Intern Med Perspect, 2021, 11(2): 206-211.
[16]	ROHLIN O, TAERI T, NETZEREAB S. Duration of CPR and impact on 30-day survival after ROSC for in-hospital cardiac arrest-A Swedish cohort study[J]. Resuscitation, 2018, 132: 1-5.
[17]	周夷霞, 韩文文, 宋丹丹. 心脏骤停患者心肺复苏后影响自主循环及预后的因素[J]. 心电与循环, 2020, 39(3): 251-255. https://www.cnki.com.cn/Article/CJFDTOTAL-XDXZ202003012.htm ZHOU Y X, HAN W W, SONG D D. The factors influencing return of spontaneous circulation and prognosis after cardiopulmonary resuscitation in patients with cardiac arrest[J]. Journal of Electrocardiology and Circulation, 2020, 39(3): 251-255. https://www.cnki.com.cn/Article/CJFDTOTAL-XDXZ202003012.htm
[18]	申前进, 江一帆, 陆洋, 等. 超长心肺复苏成功因素分析[J]. 中国临床研究, 2018, 31(1): 39-42. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201801011.htm SHEN Q J, JIANG Y F, LU Y, et al. Analysis of successful factors of ultra-long cardiopulmonary resuscitation[J]. Chinese Journal of Clinical Research, 2018, 31(1): 39-42. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201801011.htm
[19]	赵梦龙, 郭凯, 马永刚, 等. 心搏骤停患者初始心律影响因素分析[J]. 中国全科医学, 2017, 20(11): 1379-1382. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201711024.htm ZHAO M L, GUO K, MA Y G, et al. Influencing Factors of Cardiac Arrest Patients with Initial Rhythms[J]. Chinese General Practice, 2017, 20(11): 1379-1382. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201711024.htm
[20]	FOTHERGILL R T, EMMERSON A C, LYER R, et al. Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest[J]. Resuscitation, 2019, 138: 316-321.