Efficacy of combined acupuncture in the treatment of in-hospital cardiac arrest: a retrospective analysis of 120 cases
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摘要: 目的 探讨联合针刺干预院内心脏骤停(in-hospital cardiac arrest，IHCA)患者临床疗效，以提供对IHCA中西医结合治疗策略的理论依据。方法 对广东省中医院急诊乌斯坦因登记模式数据库进行回顾性分析，选择2013年10月—2021年9月的IHCA为研究对象，根据纳入排除标准筛选出120例患者，根据是否进行针刺干预分为针刺组以及非针刺组。提取一般信息，基础疾病、抢救情况等，以自主循环恢复(return of spontaneous circulation，ROSC)成功率、ROSC维持时间、神经功能评价为主要指标，以实验室指标、危重症评分、28 d死亡率等为次要指标。结果 针刺组ROSC成功率为65.6%，与非针刺组(43.2%)比较，差异有统计学意义(P < 0.05)。针刺组与非针刺组ROSC维持时间方面比较[≤20 min：2例(9.5%)vs.9例(23.7%)，20 min~24 h：13例(61.9%)vs.16例(42.1%)，>24 h：6例(28.6%)vs.13例(34.2%)]，差异无统计学意义(P>0.05)。以28 d为观察终点进行生存分析，针刺组的平均生存天数为(3.226±1.242) d(95%CI：0.791~5.661 d)，非针刺组的平均生存天数为(2.352±0.692) d(95%CI：0.996~3.709 d)。Kaplan-Meier生存分析提示两组的生存曲线相同，差异无统计学意义(χ2=3.025，P=0.081)。两组各个时间点的其他指标，如血流动力学指标、血常规、血气分析、肝肾凝血功能、危重评分及器官功能支持手段等进行比较，均差异无统计学意义(均P>0.05)。结论 联合针刺救治IHCA无严重不良事件及负性结果，具有更高ROSC成功率，更稳定的ROSC比例的优势。这可能与针刺对ROSC早期的血流动力学的稳定作用有关，有一定的探索价值。Abstract: Objective To explore the clinical efficacy of combined acupuncture intervention for patients with in-hospital cardiac arrest(IHCA) to provide a theoretical basis for the integrated Chinese and Western medicine treatment strategy for IHCA.Methods A retrospective analysis was performed on the emergency Ustein registration model database of the Guangdong Provincial Hospital of Chinese Medicine. IHCA patients were selected as the research subjects from October 2013 to September 2021. According to the inclusion and exclusion criteria, 120 patients were screened and divided into an acupuncture group and a non-acupuncture group to determine whether or not acupuncture intervention was performed. General information, underlying diseases, and rescue conditions were extracted. The success rate of return of spontaneous circulation(ROSC), ROSC maintenance time, and neurological function evaluation were used as the primary outcomes. In contrast, the laboratory indicators, critical illness scores, and 28-day mortality were secondary outcomes.Results The ROSC success rate between the two groups(65.6% in the acupuncture group vs. 43.2% in the non-acupuncture group) was significantly different(P < 0.05). The comparison of ROSC maintenance time between the two groups was: ≤20 min in 2(9.5%): 9(23.7%), 20 min-24 h in 13(61.9%): 16(42.1%), and>24 h in 6(28.6%): 13(34.2%), which was not statistically significant(P>0.05). Survival analysis was performed with 28 days as the observation endpoint. The average survival days in the acupuncture group were(3.226±1.242)days(95%CI: 0.791-5.661), and the non-acupuncture group were(2.352±0.692)days(95%CI: 0.996-3.709). Kaplan-Meier survival analysis showed that the survival curves of the two groups were the same(χ2=3.025, P=0.081). There was no statistical significance in other indicators at each time point between the two groups, such as hemodynamic indicators, blood routine, blood gas analysis, liver and kidney coagulation function, critical score and organ function support measures(all P>0.05).Conclusion Combined acupuncture treatment of IHCA has no serious adverse events or negative results and has a higher ROSC success rate and a more stable ROSC ratio. This advantage may be related to the stabilizing effect of acupuncture on the hemodynamics of the early stage of ROSC, which has a specific exploration value.
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表 1 病例的基线资料比较
项目 针刺组(32例) 非针刺组(88例) P 年龄/岁 42~92 22~98 0.625 男性/例(%) 20(62.5) 55(62.5) 1.000 CA到CPR时间/min 0~9 0~6 0.949 心源性CA/例(%) 8(25.0) 21(23.9) 1.000 心肌梗死 7(87.5) 20(95.2) 0.483* 其他 1(12.5) 1(4.8) 非心源性CA/例(%) 24(75.0) 67(76.1) 酸中毒 0(0.0) 3(3.7) 1.000 低氧呼衰 4(16.7) 13(19.4) 低血压休克 3(12.5) 8(11.9) 急性脑血管病 4(16.7) 2(3.0) 脓毒症 1(4.2) 5(7.5) 0.448* 复合原因 11(44.8) 30(45.8) 无法明确原因 1(4.2) 7(10.4) 基础疾病/例(%) 冠心病 10(31.3) 26(29.5) 高血压病 17(53.1) 44(50.0) 1.000 慢性心力衰竭 0(0.0) 2(2.3) 心律失常 0(0.0) 5(5.7) 1.000* 其他心脏疾病 2(6.3) 4(4.5) 0.323* 慢性阻塞性肺病 3(9.4) 9(10.2) 0.657* 哮喘 1(3.1) 2(2.3) 1.000* 脑血管疾病 7(21.9) 17(19.3) 1.000* 糖尿病 8(33.3) 23(21.1) 0.798 慢性肾病 2(6.3) 7(8.0) 1.000 慢性血液系统性疾病(非肿瘤) 1(3.1) 1(1.1) 1.000* 免疫相关性疾病 1(3.1) 3(3.4) 0.464* 肿瘤 3(9.4) 13(14.8) 1.000* 无确切病史 2(6.3) 6(6.8) 0.554* CA抢救地点/例(%) 1.000* 抢救室 8(25.0) 22(25.0) 急诊监护室 9(28.1) 39(44.3) 急诊留观室 11(34.4) 18(20.5) 住院病房 4(12.5) 7(8.0) 其他 0(0) 2(2.3) 选穴/例(%) 0.332* 内关 2(6.3) 百会 4(12.5) 足三里 6(18.8) 内关+百会 18(56.3) 不详 2(6.3) *采用Fisher确切检验法。 
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表 2 IHCA回顾病例的主要结果比较
X±S 项目 针刺组(32例) 非针刺组(88例) P ROSC/例(%) 21(65.6) 38(43.2) 0.039 心源性CA/例(%) 4(19.0) 12(31.6) 0.370 非心源性CA/例(%) 17(81.0) 26(68.4) 可电击心律/例(%) 7(33.3) 9(23.7) 0.543 不可电击心律/例(%) 14(66.7) 29(76.3) CPR到ROSC时间/min 24.85±11.70 23.55±15.37 0.737 ROSC维持时间/例(%) 0.284* ≤20 min 2(9.5) 9(23.7) 20 min~24 h 13(61.9) 16(42.1) >24 h 6(28.6) 13(34.2) 非死亡出院/例(%) 3(9.4) 3(3.4) 0.340* 良好神经功能出院/例(%) 1(3.1) 3(3.4) 1.000* *采用Fisher确切检验法
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表 3 两组病例ROSC后次要结果比较
分组 第0天 第3天 第5天 第7天 第14天 第28天 例数 评分 例数 评分 例数 评分 例数 评分 例数 评分 例数 评分 GCS评分 针刺组 18 3~9 6 3~15 5 3~15 5 3~15 2 4~15 2 7~15 心源性CA 2 3~9 1 15 1 15 1 15 1 15 1 15 非源性CA 16 3~8 5 3~10 4 3~9 4 3~9 1 4 1 7 P 0.130 0.083 0.114 0.114 0.317 0.317 非针刺组 32 3~14 9 3~15 7 3~15 6 3~15 5 3~15 5 3~15 P 0.659 0.891 0.848 0.643 0.714 0.714 CPC评分 针刺组 18 3~4 6 1~4 5 1~4 5 1~4 2 1~4 2 1~4 心源性CA 2 3~4 1 1 1 1 1 1 1 1 1 1 非源性CA 16 3~4 5 3~4 4 4 4 4 1 4 1 4 P 0.071 0.114 0.046 0.046 0.317 0.317 非针刺组 32 1~4 9 1~4 7 1~4 6 1~4 5 1~4 5 1~4 P 0.806 0.841 0.646 0.545 1.000 1.000
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表 4 两组病例ROSC后危重主分比较
分组 第0天 第3天 第5天 第7天 第14天 第28天 例数 评分 例数 评分 例数 评分 例数 评分 例数 评分 例数 评分 SOFA 针刺组 17 3~23 6 2~16 5 1~12 5 1~19 2 0~10 2 0~8 非针刺组 25 4~18 9 2~16 7 1~14 6 1~14 5 0~12 5 0~11 P 0.613 0.793 0.678 0.554 0.619 0.619 APACHEⅡ评分 针刺组 17 0~36 6 6~35 5 3~30 5 3~30 2 3~27 2 3~22 非针刺组 25 12~36 9 12~32 7 7~28 6 9~29 5 11~25 5 11~25 P 0.755 0.884 0.695 0.831 1.000 0.542
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