不同类型初始心律的院外心搏骤停患者流行病学及预后分析

摘要

Objective To compare OHCA patients with different types of initial heart rhythm in the difference of epidemiological characteristics and prognosis.Methods Using Utstein pattern to collect clinical data of 612 OHCA patients cured by the emergency department (ED) of Zhejiang Provincial People's Hospital,Shaoxing Emergency Medical Service Center and Ningbo Emergency Medical Service Center from January 2012 to October 2016,and retrospectively analyze their heart rhythm,age,gender,location of attack,witnessed or not,bystander CPR,response time of first-aid,possible pathogeny,return of spontaneous circulation (ROSC) at site or en-route,ROSC in emergency ward,admission to hospital and survival to hospital discharge.And compare the epidemiological characteristics and prognosis of patients with a shockable rhythm (92 cases) and the patients with a nonshockable rhythm (520 cases).Results Patients with a shockable rhythm are younger than the patients with a nonshockable rhythm,Patients with a shockable rhythm tended to attack in public and work places,while the patients t with a nonshockable rhythm mostly attack at home.Among patients with a shockable rhythm,the rate of accept bystander CPR is higher;Among OHCA patients whose possible pathogeny are trauma,patients with a nonshockable rhythm are more;and the first-aid reactivc timc of patients with a shockable rhythm is less (P ＜ 0.05).In the prognostic indicator of (ROSC) at site or en-route,ROSC in emergency ward,and admission to hospital and survival to hospital discharge,patients with a shockable rhythm are better than the patients twith a nonshockable rhythm.Conclusions OHCA with different types of initial rhythm have different epidemiological characteristics.Prognosis of patients that cannot support electric shock are worse,Out-of-hospital survival chains should be highly valued to avoid the occurrence of cannot support electric shock.%目的 比较不同类型初始心律的院外心搏骤停(OHCA)患者在流行病学特征及预后的差异.方法 参照Utstein模式收集2012年1月至2016年10月期间浙江省人民医院急诊科、绍兴市急救中心和宁波市急救中心接诊的612例OHCA患者的临床资料,回顾性分析其初始心律、年龄、性别、发作地点、是否被目击、目击者心肺复苏(CPR)、急救反应时间、可能病因、现场/途中自主循环恢复(ROSC)、急诊室ROSC、存活入院及存活出院等,并比较可电击心律患者(92例)与不可电击心律患者(520例)的流行病学特征及预后.结果 可电击心律患者的年龄比不可电击心律患者年轻;可电击心律的患者更多地发生在公共场所和工作场所,而不可电击心律患者更多地发生在家里;可电击心律患者中接受目击者CPR的比例更高;可能病因为创伤的OHCA患者中表现为不可电击心律者多于可电击心律;可电击心律患者的急救反应时间少于不可电击心律患者(均P＜0.05).可电击心律患者在现场/途中ROSC、急诊室ROSC、存活住院及存活出院等各项预后指标上均优于不可电击心律患者(均P＜0.05).结论 不同类型初始心律的OHCA在流行病学上有各自的特征,不可电击心律的预后较差,应重视院外生存链以避免出现不可电击心律.