摘要目的 探讨急性心肌梗死(AMI)后心脏骤停(CA)患者恢复自主循环(ROSC)和2年存活的影响因素,ROSC后各因素的生存时间及对2年生存的影响.方法 研究温州医科大附属第一医院2005年1月至2015年1月因AMI致CA并接受心肺复苏(CPR)患者的登记资料,对存活患者随访2年.用单因素Logistic回归分析AMI后CA患者ROSC预后和ROSC患者2年存活预后影响因素,选择有统计学意义的因素分别进行多因素非条件Logistic回归分析.用中位数和四分位数描述ROSC后患者2年期各因素的生存时间,用Kaplan-Meier生存曲线分析因素对2年生存的影响.结果 纳入AMI后CA患者资料254例,其中ROSC 129例,2年存活71例.单因素分析示年龄≥70岁、CA时间22:00-8:00、CPR持续时间≥15 min、肾上腺素用量＞5 mg为ROSC预后不利因素;CA前左室射血分数(LVEF)≥40％、CA时有可除颤心律、经皮冠状动脉介入(PCI)治疗为ROSC预后有利因素.年龄≥70岁、CA时气管插管、肾上腺素用量＞5 mg、心源性休克为2年存活预后不利因素;男性、CA前活动自如、PCI治疗为2年存活预后有利因素.多因素分析示年龄、CPR持续时间、肾上腺素用量、CA前LVEF、CA时心律、PCI治疗是影响ROSC的独立预测因素,年龄、PCI治疗是影响2年存活的独立预测因素.ROSC后患者各因素相关生存时间中,心包破裂、肾上腺素用量＞5 mg、癌症、心源性休克的25％值及中位数值较小,PCI治疗的25％值最大(216 d).Kaplan-Meier生存分析提示年龄≥70岁为2年生存不利因素(Log-rank检验,P=0.007),PCI治疗为2年生存有利因素(Log-rank检验,P＜0.01).PCI治疗预后比较分析显示PCI效果与PCI时机、病变血管数目及责任血管情况相关.结论 年龄≥70岁对ROSC、2年存活均为不利因素,PCI治疗对ROSC、2年存活均为有利因素.

abstractsObjective To assess the factors associated with the restoration of spontaneous circulation (ROSC) and 2-year survival prognosis in patients with cardiac arrest (CA) after acute myocardial infarction (AMI),and after ROSC,the effects of various factors on midian survival time and on 2-year survival.Methods In a registry study from January 2005 to January 2015,all consecutive AMI-induced CA patients treated with cardiopulmonary resuscitation (CPR) admitted to our hospital were enrolled.The survivors were followed-up for 2 years.Univariate analysis was applied to evaluate factors associated with rate of ROSC and 2-year survival.Multivariable logistic regression analysis was applied to evaluate statistically significant factors in the univariate analysis.Medians with inter-quartile ranges were used to describe 2-year survival time affected by various factors after ROSC.Kaplan-Meier survival curve analysis was used to evaluate the effect of factors on 2-year survival.Results A total of 254 cases with CA after AMI were enrolled,including 129 cases of ROSC and 71 cases of 2-year survival.Univariate analysis showed age ≥ 70 years,CA occurred during 22:00-8:00,the duration time ofCPR ≥ 15 min and adrenaline dosage ＞ 5 mg were unfavorable predictors of ROSC;while,left ventricular ejection fraction (LVEF) ≥ 40％ before CA,shockable rhythm and percutaneous coronary intervention (PCI) therapy were favorable predictors.Besides,age ≥ 70 years,intubation during CPR,adrenaline dosage ＞ 5 mg and cardiogenic shock were unfavorable predictors of 2-year survival;While,male,normal daily activity before CA and PCI treatment were favorable predictors.Multivariable analysis showed age,the duration of CPR,adrenaline dosage,LVEF before CA,the rhythm during CPR and PCI therapy were independent predictors of ROSC.Age and PCI therapy were independent predictors of 2-year survival.Among patients,the survival time was affected by various factors after ROSC,and the factors with minimum 25％ and small median value were associated with cardiac rupture,cancer,adrenaline dosage ＞ 5 mg and cardiogenic shock.The factor with maximum 25％ value was PCI treatment (216 days).Kaplan-Meier survival analysis suggested that age ≥ 70 years was an unfavorable factor of 2-years survival (Log-rank test,P=0.007);while,PCI treatment was a favorable factor (Log-rank test,P＜0.01).PCI-related prognosis analysis showed that the effectiveness of PCI was related to the timing of PCI,the number of infarctrelated artery and the difference in culprit lesion.Conclusions The age ≥ 70 years was disadvantageous to both ROSC and 2-year survival.PCI treatment was favorable to both ROSC and 2-year survival.