关于院内心脏骤停患者复苏时限的研究

发布时间：2018-12-27 20:26

【摘要】：背景:IHCA患者的死亡率较高,但其合理的复苏时限尚不明确。目的:探讨常规30分钟复苏时限的合理性;研究不同性别、年龄、初始心律及病因对复苏时长的影响。方法:回顾分析2013.12.1-2014.12.31全国14所三甲医院急诊科内出现IHCA的患者的基本资料。以30分钟的复苏时长为界限将患者分为常规组和超长组,比较两组患者的基本资料、病因及预后。将患者按性别、年龄、初始心律及病因分组,比较各组ROSC患者的复苏时长有无差异。将患者按胸外按压方式分为徒手胸外按压组与机械胸外按压组,比较两组患者的预后。结果:常规组患者的ROSC率及出院存活率显著高于超长组患者(67.5%vs 7.4%,10.1%vs0)。不同性别、不同年龄、不同初始心律的ROSC患者的复苏时长之间无统计学差异(P0.05)。病因为创伤的ROSC患者的复苏时长短于病因为心律失常、心力衰竭、肺栓塞的ROSC患者,病因为肺栓塞的ROSC患者的复苏时长长于病因为急性心肌梗死、心律失常、心力衰竭、重症肺炎、创伤、脓毒血症、脑卒中的ROSC患者。徒手胸外按压组与机械胸外按压组相比,在出院存活率方面无统计学差异(P0.05)。结论:超长CPR可以改善IHCA患者的总ROSC率,但不改善生存率;对于肺栓塞所致的IHCA患者,常常需要进行超长CPR;对于超长CPR,可以考虑使用复苏机进行复苏。
[Abstract]:Background: the mortality rate of IHCA patients is high, but the reasonable duration of resuscitation is not clear. Objective: to explore the rationality of 30 minute resuscitation duration and to study the effects of sex, age, initial rhythm and etiology on the duration of resuscitation. Methods: the basic data of patients with IHCA in emergency department of 14 third class hospitals in China from December 1 to December 31, 2013 were analyzed retrospectively. The patients were divided into two groups according to the duration of 30 minutes resuscitation. The basic data, etiology and prognosis of the two groups were compared. The patients were grouped according to sex, age, initial rhythm and etiology to compare the duration of ROSC resuscitation. The patients were divided into two groups according to the mode of chest pressing: bare hand external chest compression and mechanical chest pressing. The prognosis of the two groups was compared. Results: the ROSC rate and discharge survival rate in routine group were significantly higher than those in super long group (67.5%vs 7. 4 and 10. 1 vs 0). There was no significant difference in the duration of resuscitation between ROSC patients with different gender, age and initial rhythm (P0.05). The duration of resuscitation in patients with traumatic ROSC is longer than that in patients with ROSC with pulmonary embolism, with heart failure, with acute myocardial infarction, arrhythmia, heart failure, and the cause of pulmonary embolism is resuscitation in ROSC patients longer than in patients with acute myocardial infarction, arrhythmia, heart failure. Severe pneumonia, trauma, sepsis, stroke in ROSC patients. There was no significant difference in the survival rate of discharge between the two groups (P0.05). Conclusion: Ultra-long CPR can improve the total ROSC rate of IHCA patients, but not improve the survival rate. For patients with IHCA caused by pulmonary embolism, it is often necessary to carry out super-long CPR; for super-long CPR, patients to consider the use of resuscitation machine for resuscitation.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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