Analyze the factors influencing the success rate of cardiopulmonary resuscitation in adult patients with cardiac arrest in hospital and the relationship with prognosis
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摘要: 目的 分析院内成人心脏骤停患者心肺复苏抢救成功率的影响因素以及与预后的关系。方法 收集本院2023年1月1日-12月31日成人心脏骤停患者资料，根据ROSC是否恢复分为ROSC有效组和无效组，分析两组患者的心脏骤停发生率、ROSC率、24 h存活率、7 d及28 d神经功能恢复情况；同时分析影响ROSC恢复的因素。结果 230例年龄≥14岁的院内心脏骤停患者中，按照纳入及排除标准，最终110例纳入研究，64例ROSC成功，ROSC恢复率为58.18%；与ROSC无效组相比，ROSC有效组基础疾病(尤其是呼吸系统疾病)占比更低[14(21.88%)vs. 19(41.3%)]，复苏持续时间更短[14.50(5.00，23.00) vs. 48.50(32.25，64.50)]，发生院内心脏骤停次数更少，心脏骤停发生及实施地点主要在ICU，差异均有统计学意义(P < 0.05)。经二分类logistic回归分析：心脏骤停发生地点及实施地点、呼吸系统疾病、复苏持续时间、院内心脏骤停次数是心肺复苏抢救成功率的影响因素(P < 0.05)。结论 基础疾病(尤其是呼吸系统疾病)、心脏骤停发生地点及实施地点、复苏持续时间、院内心脏骤停次数均影响IHCA患者心肺复苏抢救成功率。同时应加强处理重症监护病房以外的临床科室CPR质量和团队抢救效率，以提高抢救成功率。Abstract: Objective To analyze the factors affecting the success rate of cardiopulmonary resuscitation in adult patients with cardiac arrest in hospitals and the relationship with prognosis.Methods The data of adult patients with cardiac arrest in our hospital from January 1 to December 31, 2023 were collected and divided into ROSC effective group and ineffective group according to whether ROSC was recovered. The incidence of cardiac arrest, ROSC rate, 24-hour survival rate, 7-day and 28-day recovery of neurological function of the two groups were analyzed. The factors affecting the recovery of ROSC were analyzed.Results Among 230 patients with in-hospital cardiac arrest aged ≥14 years, 110 cases were included in the study according to inclusion and exclusion criteria, 64 cases were ROSC successful, and the ROSC recovery rate was 58.18%. Compared with the ROSC ineffective group, the ROSC effective group had a lower proportion of underlying diseases(especially respiratory diseases) [14 cases(21.88%) vs. 19(41.3%)], and the duration of resuscitation was shorter[14.50(5.00, 23.00) vs. 48.50(32.25, 64.50)]. The number of in-hospital cardiac arrest was less, and the place of occurrence and implementation of cardiac arrest were mainly in ICU, the difference was statistically significant(P < 0.05). Binary logistic regression analysis showed that the place of occurrence and execution of cardiac arrest, respiratory disease, duration of resuscitation and number of cardiac arrest in hospital were the factors influencing the success rate of cardiopulmonary resuscitation(P < 0.05).Conclusion Underlying diseases(especially respiratory diseases), place of occurrence and execution of cardiac arrest, duration of resuscitation and number of cardiac arrest in hospital all affect the success rate of cardiopulmonary resuscitation in patients with IHCA. At the same time, the quality of CPR and the efficiency of team rescue in clinical departments other than intensive care units should be strengthened to improve the success rate of rescue.
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表 1 脑功能表现分级(CPC)评分量表
分级 表现 1级 脑功能完好：患者清醒警觉，有正常生活和工作能力 2级 中度脑功能残疾：患者清醒，可在特定环境中部分时间工作或独立完成日常活动 3级 严重脑功能残疾：患者清醒，但需依赖他人日常帮助，保留有限的认知力 4级 昏迷及植物状态：患者无知觉，对环境无意识，无认知力 5级 死亡：患者被确认脑死亡或传统标准认定的死亡 
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表 2 两组IHCA-CPR患者临床资料比较
指标 ROSC无效组 ROSC有效组 t/Z/χ2 P 年龄/岁 65.04±18.85 62.22±16.72 0.837 0.404 性别/例 0.679 0.410 男 33 42 女 13 22 既往史/例(%) 心血管疾病 32(69.57) 44(68.75) 0.055 0.815 脑血管疾病 9(19.57) 16(24.24) 0.618 0.432 糖尿病 15(32.6) 20(31.25) 0.001 0.999 肾脏疾病 11(23.91) 11(16.67) 0.570 0.450 呼吸系统疾病 19(41.3) 14(21.88) 4.139 0.042 恶性肿瘤 10(21.73) 7(10.94) 2.086 0.149 其他 27(61.36) 40(62.5) 0.446 0.504 心脏骤停原发疾病/例 0.413 0.521 心源性疾病 17 19 非心源性疾病 29 45 住院科室/例 13.603 0.003 ICU 11 35 内科 19 13 外科 14 12 其他 2 4
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表 3 两组患者心脏骤停发生及实施地点以及发生时间
指标 ROSC无效组 ROSC有效组 t/Z/χ2 P 心脏骤停发生及实施地点/例 19.762 0.001 ICU 8 34 内科 14 13 外科 9 8 外出检查及其他 15 9 心脏骤停发生时间/例 0.027 0.870 6：00am-6：00pm 23 33 6：00pm-6：00am 23 31
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表 4 两组心肺复苏情况比较
指标 ROSC无效组 ROSC有效组 t/Z/χ2 P 是否有目击者/例 - - 否 0 0 是 46 64 初始心率/例 0.498 0.480 非VF/VT 42 56 VF/VT 4 8 复苏开始时间/例 0.492 0.483 ≤5 min 34 47 >5 min 10 17 复苏持续时间/min 48.50(32.25，64.50) 14.50(5.00，23.00) -6.704 < 0.001 电除颤/例 1.595 0.207 否 33 53 是 13 11 通气方式/例 3.191 0.074 气管插管 29 51 气囊面罩 17 13 肾上腺素/例 0.353 0.552 否 1 4 是 45 60 阿托品/例 0.083 0.773 否 29 43 是 17 21 去氨加压素/例 - - 否 46 64 是 0 0 抗心律失常药物/例 1.854 0.173 否 42 53 是 4 11 升压药物/例 1.296 0.255 否 20 20 是 26 44 碳酸氢钠/例 3.011 0.083 否 36 41 是 10 23 院内心脏骤停次数/例 19.427 < 0.001 1次 41 32 >1次 5 32 注：“-”或P≥0.05，差异无统计学意义。
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表 5 两组患者ROSC恢复后的预后分析
例 指标 ROSC无效组 ROSC有效组 t/Z/χ2 P ROSC后24 h存活情况 33.261 < 0.001 死亡 46 30 存活 0 34 ROSC后7 d神经功能 3.889 0.049 CPC 3~5级 46 57 CPC 1~2级 0 7 ROSC后28 d神经功能 3.889 0.049 CPC 3~5级 46 57 CPC 1~2级 0 7 出院存活情况 33.261 < 0.001 存活 0 34 死亡 46 30
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表 6 影响IHCA患者心肺复苏抢救有效的因素logistic回归分析
变量 B SE Wald χ2 P OR 95%CI 心脏骤停发生地点及实施地点 -0.67 0.21 9.84 0.002 0.51 0.34~0.78 呼吸系统疾病 -1.81 0.67 7.31 0.007 0.16 0.04~0.61 复苏持续时间 -0.07 0.02 18.93 < 0.005 0.93 0.90~0.96 院内心脏骤停次数 1.63 0.69 5.62 0.018 5.10 1.32~19.61 常量 3.03 1.28 5.57 0.018
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