目的：探讨影响急诊科心脏骤停患者复苏结局的相关因素。方法：回顾性分析2023年4月—2024年6月在长沙市某三甲医院急诊科进行心肺复苏的102例患者的病历资料,根据结局指标分为心肺复苏无效组和心肺复苏有效组,采用单因素分析心脏骤停患者复苏结局的影响因素,并进行多因素Logistic回归分析,依据回归结果构建预测模型,分析各因素对心脏骤停患者预后的预测价值。结果：共有102例患者纳入本研究,其中心肺复苏无效组51例,心肺复苏有效组51例,单因素分析结果显示：心脏骤停地点、肾上腺素累积使用量、导致心脏骤停的疾病系统及类别,心肺复苏术（cardiopulmonary resuscitation,CPR）时长以及血气pH值的差异具有统计学意义;多因素Logistic回归分析显示,肾上腺素累积使用量、pH值小于7.35、CPR时长是影响急诊科心脏骤停患者复苏结局的独立因素,相对于循环系统疾病,消化系统疾病突发心脏骤停的患者复苏成功率更高;基于多因素Logistic回归结果,所构建预测模型的接受者操作特性曲线（receiver operating characteristic curve,ROC）下面积为0.816（95% CI：0.736~0.895）。结论：肾上腺素累积使用量、疾病系统、CPR时长以及患者的血气pH值是影响患者复苏结局的重要因素,可用于预测心脏骤停患者的预后,需密切关注,并积极干预,以进一步提高救治成功率。
Abstract
Objective To explore the relevant factors affecting the resuscitation outcomes of emergency department cardiac arrest patients. Methods A retrospective analysis was conducted on the medical records of 102 patients who underwent cardiopulmonary resuscitation (CPR) in the emergency department of a tertiary hospital in Changsha from April 2023 to June 2024. The patients were divided into two groups based on outcome indicators: the CPR ineffective group and the CPR effective group. Univariate analysis was used to determine the influencing factors of resuscitation outcomes in patients with cardiac arrest, and multiple logistic regression analysis was conducted. Based on the regression results, a prediction model was constructed to analyze the predictive value of each factor on the prognosis of patients with cardiac arrest. Results A total of 102 patients were included in this study, with 51 in the ineffective group of central pulmonary resuscitation and 51 in the effective group of cardiopulmonary resuscitation. Univariate analysis showed that there were statistically significant differences in the location of cardiac arrest, cumulative use of adrenaline, disease system and category that caused cardiac arrest, duration of cardiopulmonary resuscitation (CPR), and blood gas pH value; Multivariate logistic regression analysis showed that the cumulative use of adrenaline, pH value less than 7.35, and CPR duration were independent factors affecting the resuscitation outcome of emergency department cardiac arrest patients. Compared with circulatory system diseases, patients with sudden cardiac arrest due to digestive system diseases had a higher success rate of resuscitation; Based on the multi factor logistic regression results, the area under the receiver operating characteristic curve (ROC) of the constructed prediction model is 0.816 (95% CI: 0.736-0.895). Conclusion The cumulative use of adrenaline, disease system, CPR duration, and patient's blood gas pH are important factors affecting the outcome of patient resuscitation, which can be used to predict the prognosis of cardiac arrest patients. Close attention and active intervention are needed to further improve the success rate of treatment.
关键词
急诊科 /
心脏骤停 /
心肺复苏 /
自主循环恢复
Key words
emergency department /
cardiac arrest /
cardiopulmonary resuscitation /
return of spontaneous circulation
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基金
湖南省2023年度第十一批创新型省份建设专项资金项目“PDCA联合情景模拟法提高社区居民急救能力的效果研究”（2023ZK4206）
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