目的分析影响急诊科心脏骤停患者院前心肺复苏成功的因素。方法回顾性分析2016年1月至2018年3月陆军军医大学大坪医院110例接受院前心肺复苏抢救的心脏骤停患者的临床资料,根据抢救结果将患者分为成功组(42例)和未成功组(68例),比较两...目的分析影响急诊科心脏骤停患者院前心肺复苏成功的因素。方法回顾性分析2016年1月至2018年3月陆军军医大学大坪医院110例接受院前心肺复苏抢救的心脏骤停患者的临床资料,根据抢救结果将患者分为成功组(42例)和未成功组(68例),比较两组患者的临床资料,采用Logistic回归分析对院前心肺复苏成功的影响因素进行分析。结果在所有导致心脏骤停原因中,心源性原因患者复苏成功率最高,占45.12%,其次为中枢神经系统,占27.27%;车祸所占比例较低,为12.5%。成功组与未成功组患者心脏骤停绝对时间[(18.62±8.05) min vs(24.05±9.34) min]、开始抢救时间[(5.64±1.48) min vs (9.26±1.94) min]、气管插管时间[(6.18±2.94) min vs (10.14±4.16) min]和肾上腺素累积用量[(8.34±5.48) mg vs (18.38±9.64) mg]比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,心源性疾病、心室纤颤、无脉搏电活动、应用电除颤和肾上腺素用量<4 mg是心肺复苏抢救成功的影响因素(P<0.05)。结论院前心脏骤停患者心肺复苏成功的影响因素多且复杂,需要同时建立多项措施以减少各类危险因素的发生。展开更多
BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine...BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.展开更多
文摘目的分析影响急诊科心脏骤停患者院前心肺复苏成功的因素。方法回顾性分析2016年1月至2018年3月陆军军医大学大坪医院110例接受院前心肺复苏抢救的心脏骤停患者的临床资料,根据抢救结果将患者分为成功组(42例)和未成功组(68例),比较两组患者的临床资料,采用Logistic回归分析对院前心肺复苏成功的影响因素进行分析。结果在所有导致心脏骤停原因中,心源性原因患者复苏成功率最高,占45.12%,其次为中枢神经系统,占27.27%;车祸所占比例较低,为12.5%。成功组与未成功组患者心脏骤停绝对时间[(18.62±8.05) min vs(24.05±9.34) min]、开始抢救时间[(5.64±1.48) min vs (9.26±1.94) min]、气管插管时间[(6.18±2.94) min vs (10.14±4.16) min]和肾上腺素累积用量[(8.34±5.48) mg vs (18.38±9.64) mg]比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,心源性疾病、心室纤颤、无脉搏电活动、应用电除颤和肾上腺素用量<4 mg是心肺复苏抢救成功的影响因素(P<0.05)。结论院前心脏骤停患者心肺复苏成功的影响因素多且复杂,需要同时建立多项措施以减少各类危险因素的发生。
基金This study was supported by grants from the National Key R&D Program of China (2017YFC0908700, 2017YFC0908703)National S&T Fundamental Resources Investigation Project (2018FY100600, 2018FY100602)+2 种基金Taishan Pandeng Scholar Program of Shandong Province (tspd20181220)Taishan Young Scholar Program of Shandong Province (tsqn20161065, tsqn201812129)Key R&D Program of Shandong Province (2020SFXGFY03, 2019GSF108073)
文摘BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.
