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Analysis of Clinical Characteristics and Resuscitation Outcomes of Adult Patients with In-hospital Cardiac Arrest
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摘要:
目的 分析重症监护室成人心脏骤停(cardiac arrest，CA)患者的临床特征及复苏结局，探讨影响其心肺复苏(cardiopulmonany resuscitation, CPR)成功率的相关因素。 方法 回顾性分析2019年9月至2020年12月吉林大学第一医院重症监护室成人CA患者的临床资料，根据结局指标将患者分为自主循环恢复(return of spontaneous circulation，ROSC)组与非ROSC组、存活出院组与死亡组，探讨影响复苏结局的相关因素。 结果 共351例CA患者纳入本研究，其中男性206例，女性145例；中位年龄为63岁。心源性因素引起的CA患者191例，CA发病时初始心律为不可除颤心律(心搏停止、无脉性电活动)的患者267例。经CPR治疗后，152例ROSC，其中42例存活出院。单因素逻辑回归分析显示，冠心病、不可除颤心律、抢救过程中未出现可除颤心律、无电除颤、无紧急气管插管为降低ROSC发生的可能因素，年龄小、CPR持续时间≤30 min、肾上腺素累积剂量小为增加ROSC发生的可能因素；非心源性病因、不可除颤心律、无电除颤、抢救过程中未出现可除颤心律降低患者存活出院的可能，CPR持续时间≤30 min、肾上腺素累积剂量小增加患者存活出院的可能。多因素逻辑回归分析显示，CPR持续时间＞30 min是ROSC的独立危险因素，年龄小、紧急气管插管、肾上腺素累积剂量小是ROSC的独立保护因素；CPR持续时间＞30 min是存活出院的独立危险因素，心源性病因、抢救过程中出现可除颤心律是存活出院的独立保护因素。 结论 CPR持续时间、肾上腺素累积剂量、CA初始心律、电除颤、抢救过程中出现可除颤心律是ROSC和存活出院的相关影响因素，且CPR持续时间＞30 min为独立危险因素，临床上应高度关注上述因素，以改善CA患者心肺复苏的结局。 Abstract:Objective To analyze the clinical features and resuscitation outcome of adult patients with cardiac arrest (CA) in intensive care unit, and discuss the related factors affecting the success rate of cardiopulmonary resuscitation in adult patients with CA. Methods The clinical data of CA patients in the intensive care unit of the First Hospital of Jilin University from September 2019 to December 2020 were retrospectively analyzed. According to the outcome indicators, the patients were divided into return of spontaneous circulation (ROSC) group and non-ROSC group, survival-discharge group and death group. The relevant factors affecting resuscitation outcome were discussed. Results A total of 351 patients with CA were included in this study, including 206 males and 145 females; the median age was 63 years. There were 191 patients with cardiogenic CA and 267 patients with non-defibrillation rhythm (cardiac arrest and no electrical activity) at the onset of CA. After treatment with CPR, 152 patients had ROSC, of whom 42 survived and were discharged. Univariate Logistic regression analysis showed that coronary artery disease, non-defibrillation rhythm, no defibrillation rhythm during resuscitation, no electric defibrillation, and no emergency endotracheal intubation were the possible factors that reduced the incidence of ROSC. Young age, CPR duration ≤30 min, and small cumulative dose of epinephrine were the possible factors that increased the incidence of ROSC. Non-cardiogenic etiology, non-defibrillable rhythm, no electric defibrillation, and no defibrillable rhythm during resuscitation decreased the likelihood of survival and discharge, whereas CPR duration ≤30 min and a small cumulative dose of epinephrine increased the likelihood of survival and discharge. Multivariate Logistic regression analysis showed that CPR duration > 30 min was an independent risk factor for ROSC, and young age, emergency tracheal intubation, and small cumulative epinephrine dose were independent protective factors for ROSC. CPR duration > 30 min was an independent risk factor for survival and discharge, and cardiogenic etiology and presence of defibrillable rhythm during resuscitation were independent protective factors for survival and discharge. Conclusions CPR duration, cumulative epinephrine dose, CA initial rhythm, electric defibrillation, and emergence of defibrillable rhythm during resuscitation are associated factors for ROSC as well as survival and discharge, and CPR duration > 30 min is an independent risk factor. Clinical attention should be paid to these factors in order to improve the outcome of cardiopulmonary resuscitation. 作者贡献：赵婷婷负责资料收集和论文撰写；赵媛媛提供论文撰写意见；邢吉红负责论文设计及审校。利益冲突：所有作者均声明不存在利益冲突 -
表 1 成人CA患者一般临床资料及抢救措施(n=351)
指标 例数[n(%)] 性别 男性 206 (58.7) 女性 145(41.3) 初始心律 可除颤心律 84(24.0) 无脉性室性心动过速 16(4.6) 心室颤动 68(19.4) 不可除颤心律 267(76.0) 无脉性电活动 176(50.1) 心搏停止 91(25.9) CPR持续时间(min) ≤30 236(67.2) ＞30 115(32.8) 使用电除颤 是 114(32.5) 否 237(67.5) 使用肾上腺素 是 299(85.2) 否 52(14.8) 紧急气管插管 是 98(27.9) 否 253(72.1) CA：心脏骤停；CPR：心肺复苏 
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表 2 成人CA患者ROSC和存活出院的单因素逻辑回归分析
相关因素 ROSC(n=152) 存活出院(n=42) 例数[n(%)] OR(95% CI) P值 例数[n(%)] OR(95% CI) P值 年龄(岁) 63(52, 70)* 0.98(0.97~0.99) 0.018 - - - ≤60 86(56.6) 1.00 0.062 24(57.1) 1.00 0.376 ＞60 66(43.4) 1.51(0.98~2.34) 18(42.9) 1.27(0.66~2.43) 性别[n(%)] 0.483 0.480 男性 66(43, 4) 1.00 20(47.6) 1.00 女性 86(56.6) 1.17(0.76~1.80) 22(52.4) 1.34(0.70~2.56) 吸烟[n(%)] 38(25.0) 0.80(0.49~1.32) 0.389 9(21.4) 1.09(0.50~2.39) 0.822 饮酒[n(%)] 27(17.8) 1.02(0.59~1.77) 0.937 6(14.3) 1.36(0.57~3.37) 0.510 冠心病[n(%)] 71(46.7) 1.56(1.02~2.39) 0.040 27(64.3) 1.70(0.87~3.32) 0.118 无高血压病[n(%)] 59(38.8) 0.85(0.55~1.31) 0.462 18(42.9) 1.09(0.57~2.09) 0.797 无糖尿病[n(%)] 43(28.3) 1.01(0.63~1.61) 0.976 9(21.4) 0.66(0.31~1.44) 0.298 CA病因[n(%)] 0.950 ＜0.001 心源性 69(45.4) 1.00 6(14.3) 1.00 非心源性 83(54.6) 1.01(0.66~1.55) 36(85.7) 5.96(2.44~14.55) 初始心律[n(%)] ＜0.001 ＜0.001 可除颤 100(65.8) 1.00 15(35.7) 1.00 不可除颤 52(34.2) 2.71(1.64~4.50) 27(64.3) 7.96(3.98~15.92) 抢救过程中出现可除颤心律[n(%)] 0.003 ＜0.001 是 86(56.6) 1.00 9(21.4) 1.00 否 66(43.4) 1.96(1.26~3.06) 33(78.6) 9.06(4.18~19.72) CPR持续时间[n(%)] ＜0.001 0.001 ≤30 min 146(96.1) 0.03(0.01~0.08) 40(95.2) 0.09(0.02~0.37) ＞30 min 6(3.9) 1.00 2(4.8) 1.00 使用电除颤[n(%)] 0.004 ＜0.001 是 90(59.2) 1.00 11(26.2) 1.00 否 62(40.8) 1.95(1.24~3.06) 31(73.8) 7.67(3.69~15.96) 紧急气管插管[n(%)] ＜0.001 0.318 是 93(61.2) 1.00 33(78.6) 1.00 否 59(38.8) 2.60(1.61~4.20) 9(21.4) 0.67(0.31~1.47) 肾上腺素累积剂量(mg) 2(0, 4)* 0.75(0.70~0.80) ＜0.001 0(0, 1)* 0.57(0.45~0.71) ＜0.001 CA、CPR：同表 1；ROSC：自主循环恢复；*采用中位数(四分位数)表示
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