摘要目的 分析上海市心室纤颤(室颤)患者院前急救现状及复苏相关因素,探讨提高复苏成功率的相关措施.方法 回顾性分析2013年1月至2016年12月上海市医疗急救中心接诊的院外室颤患者资料,收集患者的一般临床资料、院前急救时间、院前复苏及最终复苏情况,用Logistic回归分析复苏成功相关的因素.结果 2013至2016年上海市医疗急救中心接收可疑心源性心搏骤停患者21096例,室性心动过速(13例)、心室停搏(20995例)患者均予排除,最终纳入88例院前室颤患者,其中男性62例,女性26例;年龄(63.22±16.15)岁;目击者行心肺复苏(CPR)者仅21例(占23.86％);白天(08:00至20:00)呼救57例,夜间呼救31例;急救中心接到求救电话至急救人员到达现场的时间(响应时间)为(6.47±4.13)min,急救人员到达现场至离开现场的时间(现场时间)为(14.76±10.88)min,急救人员离开现场至到达医院急诊的时间(转运时间)为(5.95±4.00)min,4年间以及白天与夜间的院前急救时间差异均无统计学意义.2013至2016年院前复苏成功率逐年降低〔分别为95.65％(22/23)、87.50％(14/16)、83.33％(20/24)、80.00％(20/25),χ2=1.895,P=0.595〕,最终复苏成功率逐年升高〔分别为21.74％(5/23)、31.25％(5/16)、37.50％(9/24)、40.00％(10/25),χ2=2.862,P=0.413〕.进行1次、2次、≥3次除颤的室颤患者院前复苏成功率分别为35.23％(31/88)、23.08％(12/52)、89.19％(33/37;χ2=42.811,P=0.000),说明多次除颤可显著增加院前复苏成功率.最终复苏成功组现场时间明显短于未成功组(min:10.85±8.83比16.79±11.36,t=2.367,P=0.020),心电监护仪记录室颤至恢复室上性心律的时间(复苏成功用时)明显短于未成功组(min:3.24±3.17比7.43±6.64,t=3.175,P=0.002),说明用时越短,最终复苏成功率越高.Logistic回归分析显示,复苏成功用时长是院外室颤患者最终未成功复苏的危险因素〔优势比(OR)=0.771,P=0.024〕;而性别、年龄、有无目击者CPR、呼救时间段、响应时间、现场时间、转运时间对院前复苏成功和最终复苏成功均无显著影响;此外,在院前复苏成功的患者中,进行1次、2次、≥3次除颤者的最终复苏成功率分别为48.39％(15/31)、58.33％(7/12)、21.21％(7/33),差异具有统计学意义(χ2=7.460,P=0.024).结论 2013至2016年上海市室颤急救响应时间、院前复苏成功率及最终复苏成功率无明显变化.虽然多次除颤可显著增加院外室颤患者的院前复苏成功率,但在院前复苏成功的患者中,随除颤次数增多,最终复苏成功率明显降低.此外,复苏成功用时长、现场急救时间长者最终预后不良.

abstractsObjective To investigate the epidemiological features of out-of-hospital patients with ventricular fibrillation (VF) in Shanghai and to analysis factors associated with outcomes, and to provide evidence for improving the success rate of VF.Methods The data of patients with VF admitted to Shanghai Medical Emergency Center from January 2013 to December 2016 were analyzed retrospectively. All the data were recorded including the clinical data, medical service time, return of spontaneous circulation (ROSC) at scene/en route, survival to hospital discharge. Factors that associated with successful resuscitation were analyzed by Logistic regression.Results From 2013 to 2016, 21096 patients with suspected cardiac arrest were admitted to the Shanghai Medical Emergency Center. After excluding ventricular tachycardia (13 cases) and ventricular asystole (20995 cases), 88 patients with VF were enrolled, with 62 male and 26 female; the average age was (63.22±16.15) years old. While bystander cardiopulmonary resuscitation (CPR) was performed in only 21 cases (23.86％). Fifty-seven cases occurred during the day (08:00-20:00), while 31 cases occurred in the night. And the average emergency response time was (6.47±4.13) minutes; the average on-site time was (14.76±10.88) minutes; the average transport to hospital time was (5.95±4.00) minutes. There were no significant differences in response time, on-site time and transport to hospital time each year, and there were no significant differences in emergency medical service time between day and night either. From 2013 to 2016, prehospital successful resuscitation rate was decreased by years [95.65％ (22/23), 87.50％ (14/16), 83.33％ (20/24) vs. 80.00％(20/25), respectively,χ2 = 1.895,P = 0.595]. Survival to hospital discharge rate was increased by years [21.74％ (5/23), 31.25％ (5/16), 37.50％ (9/24), 40.00％ (10/25), respectively,χ2 = 2.862,P = 0.413]. The success rate of prehospital resuscitation for patients with 1, 2, ≥3 defibrillation was 35.23％ (31/88), 23.08％ (12/52), 89.19％ (33/37), respectively (χ2 = 42.811,P = 0.000). The on-site time in successful final resuscitation group was shorter than that in final resuscitation failure group (minutes: 10.85±8.83 vs. 16.79±11.36,t = 2.367,P = 0.020), the ROSC time in successful final resuscitation group was shorter than that of final resuscitation failure group (minutes: 3.24±3.17 vs. 7.43±6.64, t = 3.175,P = 0.002). It was shown by Logistic regression that long ROSC time was the risk factor for final resuscitation failure [odds ratio (OR) = 0.771,P = 0.024]. Gender, age, availability of witnesses CPR, call time, emergency response time, on-site time and transport to hospital time had no significant impact on the prehospital successful resuscitation and final successful resuscitation. In prehospital successful resuscitation group, there was significant difference in survival to hospital discharge rate among different defibrillation times group [48.39％ (15/31), 58.33％ (7/12) vs. 21.21％ (7/33),χ2 = 7.460,P = 0.024].Conclusions From 2013 to 2016, there were no significant changes in the emergency response time, prehospital successful resuscitation rate and survival to hospital discharge rate of patients with VF in Shanghai. Though, repeated defibrillation could significantly increased prehospital successful resuscitation rate, multiple defibrillation indicated decline of survival to hospital discharge rate in prehospital successful resuscitation group. Additionally, long on-site time and long ROSC time indicated poor prognosis.