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基于Utstein模式下秦皇岛地区院外心搏骤停旁观者心肺复苏的现状分析

Current status analysis of bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Qinhuangdao region based on Utstein model

摘要:

目的:分析秦皇岛地区院外心搏骤停(OHCA)旁观者心肺复苏(BCPR)的现状及其对心肺复苏(CPR)预后的影响。方法:基于秦皇岛市Utstein模式CPR数据库,收集2018年1月至2019年1月秦皇岛市卫生应急调度中心接诊的1 162例OHCA患者的数据资料,并依据是否获得BCPR分为两组。收集患者的人口学参数(性别、年龄)、心搏骤停前参数(心搏骤停发生地点)、CPR实施参数(院前急救反应时间、心搏骤停原因初步诊断、初始心律)、CPR结果参数〔现场是否实现自主循环恢复(ROSC)、30 d存活率〕等。采用多因素Logistic回归法分析BCPR与现场ROSC的关系;同时分析实施BCPR旁观者的社会特征(性别、年龄、职业、学历、CPR知识的获取途径)。结果:1 162例OHCA患者中,剔除发生在养老院、医院等有专业医护人员的场所以及院前急救人员目击的病例,最终纳入852例OHCA患者,其中仅24例(占2.8%)获得BCPR,其余828例未获得BCPR(占97.2%)。两组患者性别、年龄、心搏骤停发生地点、院前急救反应时间、心搏骤停原因初步诊断和初始心律等比较差异均无统计学意义。与非BCPR组比较,BCPR组患者现场ROSC率和30 d存活率均明显升高〔现场ROSC率:16.7%(4/24)比5.2%(43/828),30 d存活率:8.3%(2/24)比1.3%(11/828),均 P<0.05〕。多因素Logistic回归分析显示,BCPR〔优势比( OR)=32.132,95%可信区间(95% CI)为11.129~65.471〕、心搏骤停发生地点( OR=0.080,95% CI为1.212~3.125)和院前急救反应时间( OR=0.121,95% CI为0.174~0.816)是OHCA患者现场ROSC的重要因素(均 P<0.01)。共计30名旁观者参与实施OHCA患者BCPR,其中失访2名,有效回访28名。28名旁观者以男性为主(占85.7%);年龄集中在18~40岁(占57.1%);职业主要为旅游服务行业人员(占21.5%)、学生(占17.9%)、军人(占14.3%)和公交司机(10.7%)等;学历主要为专科及以上(占85.7%);CPR知识获取途径主要为新媒体与APP(占42.9%)和讲座(占21.4%)等。 结论:秦皇岛市OHCA的BCPR实施率仅为2.8%;BCPR可提高OHCA患者院前CPR成功率和30 d存活率;有针对性地选择旅游服务行业人员、学生、军人及公交司机等人群作为CPR培训目标可能获得更显著的社会效益。

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abstracts:

Objective:To analyze the status quo of bystander cardiopulmonary resuscitation (BCPR) for out-of-hospital cardiac arrest (OHCA) in Qinhuangdao area and its influence on the prognosis of cardiopulmonary resuscitation (CPR).Methods:Based on the Utstein model CPR database of Qinhuangdao, data of 1 162 OHCA patients admitted to the Health Emergency Dispatch Center of Qinhuangdao City from January 2018 to January 2019 were collected, and they were divided into two groups according to whether BCPR was performed or not. The patients' demographic parameters (gender, age), precardiac arrest parameters (location of cardiac arrest), the parameters of the CPR (first aid response time before hospital, initial diagnosis of causes of cardiac arrest, initial cardiac rhythm) and the parameters of the CPR results [whether to achieve on-site restoration of spontaneous circulation (ROSC) and 30-day survival rate] were collected. Multivariate Logistic regression analysis was performed for the relationship between BCPR and on-site ROSC rate. The social characteristics of bystanders implementing BCPR, including gender, age, occupation, educational background, and acquisition method of CPR knowledge, were analyzed.Results:Among the 1 162 OHCA patients, the patients witnessed by professional medical personnel in nursing homes, hospitals and other places and pre-hospital emergency personnel were excluded. 852 OHCA patients were enrolled, among which only 24 patients obtained BCPR (2.8%), and the remaining 828 patients did not obtain BCPR (97.2%). There were no statistically significant differences in gender, age, location of cardiac arrest, pre-hospital emergency response time, primary diagnosis of cardiac arrest causes and initial cardiac rhythm between the two groups. Compared with the non-BCPR group, the on-site ROSC rate and the 30-day survival rate of the BCPR group were significantly increased [on-site ROSC rate: 16.7% (4/24) vs. 5.2% (43/828), 30-day survival rate: 8.3% (2/24) vs. 1.3% (11/828), both P < 0.05]. Multivariate Logistic regression analysis showed that BCPR [odds ratio ( OR) = 32.132, 95% confidence interval (95% CI) was 11.129-65.471], location of cardiac arrest ( OR = 0.080, 95% CI was 1.212-3.125) and response time during pre-hospital emergency treatment ( OR = 0.121, 95% CI was 0.174-0.816) were important factors for on-site ROSC of OHCA patients (all P < 0.01). A total of 30 bystanders participated in the implementation of OHCA patients' BCPR, excluding 2 bystanders of lost follow-up, 28 bystanders with effective return visit. The 28 bystanders of BCPR practitioners were mainly male (85.7%), the age was mainly 18-40 years old (57.1%), the occupation was mainly in the tourism service industry (21.5%), students (17.9%), soldiers (14.3%) and bus drivers (10.7%), and the education background was mainly junior college or above (85.7%), the methods of acquiring CPR knowledge mainly included APP and new media (42.9%) and lectures (21.4%). Conclusions:The BCPR implementation rate of OHCA in Qinhuangdao was only 2.8%. BCPR can improve the success rate of pre-hospital CPR and the 30-day survival rate of OHCA patients. Targeted selection of tourism service industry, students, military personnel and bus drivers as CPR training targets may obtain more significant social benefits.

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作者: 张重阳 [1] 张风云 [2] 王耀辉 [1] 孙伟 [1] 李浤岠 [3]
作者单位: 秦皇岛市第一医院急诊科,河北秦皇岛 066000 [1] 承德医学院研究生院,河北承德 067000 [2] 秦皇岛市卫生应急调度中心,河北秦皇岛 066000 [3]
期刊: 《中华危重病急救医学》2020年32卷9期 1096-1100页 MEDLINEISTICPKUCSCD
栏目名称: 论著·重症心脏
DOI: 10.3760/cma.j.cn121430-20200714-00520
发布时间: 2023-01-03
基金项目:
河北省秦皇岛市科学技术研究与发展计划项目 Qinhuangdao City Science and Technology Research and Development Planning Project of Hebei Province of China
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