摘要
目的探讨影响老年院外心搏骤停(OHCA)患者自主循环恢复(ROSC)的相关因素。方法采用回顾性分析方法,基于Utstein模式统计的院前急救数据库,收集2016年7月至2019年7月郑州人民医院急救中心接诊的OHCA患者的临床资料,包括患者性别、年龄、心搏骤停(CA)病因、是否有旁观者心肺复苏(CPR)、急救反应时间、初始心律、通气方式、是否使用肾上腺素、是否除颤、是否ROSC。按照年龄是否≥60岁分为老年组和中青年组,比较两组患者各项指标的差异。采用单因素Logistic回归分析老年患者急救反应时间与ROSC之间的关系;采用多因素Logistic回归分析影响老年患者ROSC的因素。结果共纳入3?429例成人OHCA患者,包括老年患者2?105例(61.39%),中青年患者1?324例(38.61%)。与中青年组比较,老年组患者女性占比、非心源性病因比例、初始心律为心搏停止的比例更高,急救反应时间更短,除颤比例、气管插管比例及ROSC成功率更低(均P<0.05)。其中,老年男性患者初始心律为心搏停止的比例明显高于中青年男性患者(P<0.05);老年女性患者非心源性病因比例明显高于中青年女性患者,且除颤比例明显低于中青年女性患者(均P<0.05)。多因素Logistic回归分析显示,初始心律为心搏停止与老年男性患者ROSC的关联性较强〔优势比(OR)=0.126,95%可信区间(95%CI)为0.045~0.352,P<0.05〕。老年患者急救反应时间与ROSC关系的单因素分析显示,虽然老年患者各急救反应时间与ROSC成功率无明显差异,但急救反应时间在10 min内有利于老年患者ROSC。结论年龄≥60岁的老年OHCA患者ROSC成功率很低。虽然老年患者CPR相关指标与中青年患者差异较大,但存在性别差异,老年男性患者与初始心律为心搏停止的关联性较强,老年女性患者非心源性疾病导致的OHCA更多,且可除颤心律更少。缩短急救反应时间、增加旁观者CPR可能对老年患者更有益�
Objective To investigate the factors that influence the return of spontaneous circulation(ROSC)in elderly patients suffering from out-of-hospital cardiac arrest(OHCA).Methods A retrospective study was used to collect the clinical data of OHCA patients admitted to the emergency center of Zhengzhou People's Hospital from July 2016 to July 2019 based on the pre-hospital emergency database of Utstein model.Patients'gender,age,cardiac arrest(CA)etiology,presence or absence of bystander cardiopulmonary resuscitation(CPR),emergency response time,initial cardiac rhythm,ventilation method,use of epinephrine,defibrillation and ROSC were included.The patients were divided into elderly and young groups according to whether age≥60 years old,and the differences in various indicators between the two groups were compared.Univariate Logistic regression analysis was used to analyze the relationship between emergency response time and ROSC in elderly patients and multivariate Logistic regression analysis was used to identify factors influencing ROSC in elderly patients.Results A total of 3429 adult OHCA patients were enrolled in this study,including 2105 elderly patients(61.39%),and 1324 young and middle-aged patients(38.61%).Compared to the young group,the proportion of females,non-cardiac causes and asystole as the initial rhythm was higher in the elderly group,the emergency response time was shorter,the rate of defibrillation and tracheal intubation,and the success rate of ROSC were lower(all P<0.05).Among them,the proportion of cardiac arrest as the initial rhythm in elderly male patients was significantly higher than that of young male patients(P<0.05);the proportion of non-cardiac causes in elderly female patients was significantly higher than that of young female patients,and the proportion of defibrillation was significantly lower than that of young female patients(all P<0.05).Multivariate Logistic regression analysis showed that cardiac arrest as the initial rhythm was strongly associated with ROSC in elderly male patien
作者
张芮
张思森
Zhang Rui;Zhang Sisen(The Fifth Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450003,Henan,China;Department of Emergency,People's Hospital of Henan University of Chinese Medicine/Zhengzhou People's Hospital,Zhengzhou 450003,Henan,China;Henan Engineering Research Center of Cardiopulmonary and Brain Resuscitation,Zhengzhou 450000,Henan,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2024年第3期273-278,共6页
Chinese Critical Care Medicine
基金
河南省自然科学基金面上项目(232300420059)
河南省心肺脑复苏重点实验室(工程技术研究中心)科研专项(202201281)
河南省中医药科学研究专项(2022ZY1184)
河南省医学重点学科建设项目(201626155)。
关键词
院外心搏骤停
老年人
自主循环恢复
心肺复苏
Out-of-hospital cardiac arrest
Elderly
Return of spontaneous circulation
Cardiopulmonary resuscitation
