不同类型初始心律院外心搏骤停患者流行病学及预后分析.docVIP

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] 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?粜穆苫颊叩哪炅浔炔豢傻缁餍穆苫颊吣昵幔豢傻缁餍穆傻幕颊吒?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P0.05）。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P0.05）。 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。 　　[关键词]心搏骤停；初始心律；流行病学；预后 　　[Abstract] Objective To compare the differences of the epidemiological characteristics and outcomes between different types of initial rhythm in patients with out-of-hospital cardiac arrest （OHCA）. Methods The clinical data of 612 patients with OHCA collected from 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 were analyzed retrospectively. All the data following the Utstein style included initial rhythm， age， sex， location of arrest， witnessed by bystanders， bystander CPR， EMS response time， causes of arrest， return of spontaneous circulation （ROSC） at scene/en-route， ROSC at ED， admission to hospital and survival to hospital discharge. The differences of epidemiological characteristics and outcomes between shockable initial rhythm patients （92 cases） and non-shockable patients （520 cases） were compared. Results The shockable patients were younger than the non-shockable. The shockable tended to occur in public and work places while the non-shockable in homes. More patients with shockable rhythm received bystander CPR. The shockable rhythm was more frequent than the non-shockable rhythm in patients with traumatic OHCA. The EMS response time in the shockable was shorter than in the non-shockable （P0.05）. Outcomes in the shockable were be