摘要目的:分析院内心搏骤停（IHCA）患者的预后及其影响因素。方法:采用回顾性观察性研究方法，分析2016年1月1日至2022年12月31日在中南大学湘雅二医院发生IHCA并接受心肺复苏（CPR）患者的临床资料。通过医院电子病历系统收集患者的性别、年龄、既往史、心搏骤停前相关指标〔心搏骤停前1 h神经功能、心搏骤停前24 h血红蛋白（Hb）、心搏骤停前1 h生命体征〕、首次CPR相关指标（实施时间、实施地点、初始心律、通气方式、是否除颤或使用复苏药物）、自主循环恢复（ROSC）相关指标（ROSC时和ROSC后1 h生命体征、心搏骤停后24 h Hb、IHCA次数）。比较ROSC与非ROSC患者及28 d神经功能良好〔脑功能表现分类（CPC）1～2级〕与神经功能不良（CPC 3～5级）患者的临床资料。将单因素分析中差异有统计学意义及具有临床意义的指标纳入二元多因素Logistic回归模型，分析ROSC和ROSC后28 d神经功能的影响因素；绘制受试者工作特征曲线（ROC曲线），分析28 d神经功能影响因素的预测价值。结果:共纳入277例IHCA-CPR患者，最终实现ROSC 230例（占83.0%），未实现ROSC 47例（占17.0%）；与非ROSC患者比较，ROSC患者脑血管疾病史和使用肾上腺素比例更低，初始可除颤心律比例更高；多因素Logistic回归分析显示，面罩+气管插管（以面罩为参照）有利于IHCA-CPR患者实现ROSC 〔优势比（ OR）＝2.895，95%可信区间（95% CI）为1.204～6.962， P＝0.018〕，而初始不可除颤心律则不利于IHCA-CPR患者实现ROSC（ OR＝0.349，95% CI为0.147～0.831， P＝0.017）。230例ROSC患者中，28 d神经功能良好42例（占18.3%），神经功能不良188例（占81.7%）；与神经功能良好患者比较，神经功能不良患者年龄更大，心搏骤停前1 h神经功能不良和低灌注、初始不可除颤心律、气管插管及使用肾上腺素、升压药、碳酸氢钠比例更高，除颤和使用抗心律失常药物比例、心搏骤停前后24 h Hb更低；多因素Logistic回归分析显示，女性（ OR＝6.449，95% CI为1.837～22.642， P＝0.004）、年龄大（ OR＝1.054，95% CI为1.017～1.093， P＝0.004）、心搏骤停前1 h神经功能不良（ OR＝25.044，95% CI为2.737～229.169， P＝0.004）、心搏骤停前1 h低灌注（ OR＝3.880，95% CI为1.306～11.524， P＝0.028）、CPR期间气管插管（以面罩为参照； OR＝8.712，95% CI为1.402～54.141， P＝0.020）和面罩+气管插管（以面罩为参照； OR＝11.089，95% CI为3.482～35.320， P＝0.000）、IHCA次数>1次（ OR＝4.221，95% CI为1.249～14.226， P＝0.020）与28 d神经功能不良呈正相关，是不利于IHCA-CPR患者ROSC后28 d神经功能恢复的独立危险因素，而使用抗心律失常药物（ OR＝0.345，95% CI为0.134～0.890， P＝0.028）和心搏骤停后24 h Hb（ OR＝0.983，95% CI为0.966～0.999， P＝0.043）则与28 d神经功能不良呈负相关，是有利于神经功能恢复的保护因素；ROC曲线分析显示，心搏骤停后24 h Hb预测IHCA-CPR患者ROSC后28 d神经功能不良的ROC曲线下面积（AUC）为0.659（95% CI为0.577～0.742），最佳截断值为99.5 g/L（敏感度为76.2%，特异度为57.8%）。 结论:CPR期间除颤及气管插管对于IHCA患者至关重要；低Hb（<99.5 g/L应高度关注）、年龄大、心搏骤停前1 h神经功能不良和低灌注、IHCA次数>1次均与成人IHCA复苏患者不良神经学结局显著相关。

abstractsObjective:To explore the factors influencing prognosis of patients with in-hospital cardiac arrest (IHCA).Methods:A retrospective observational study was conducted. The clinical data of patients who developed IHCA and underwent cardiopulmonary resuscitation (CPR) at the Second Xiangya Hospital of Central South University from January 1, 2016, to December 31, 2022 were analyzed. The patients' information, including gender, age, medical history, pre-cardiac arrest related parameters [1-hour pre-cardiac arrest neurological function, 24-hour pre-cardiac arrest hemoglobin (Hb) levels, 1-hour pre-cardiac arrest vital signs], initial CPR-related factors (implementation time and location, initial rhythm, ventilation method, defibrillation and resuscitation drugs) as well as restoration of spontaneous circulation (ROSC) related parameters (vital signs at ROSC and 1 hour after ROSC, 24-hour post-cardiac arrest Hb, and IHCA events), were collected through the hospital's electronic medical record system. The clinical data were compared between ROSC and non-ROSC patients as well as between patients with favorable neurological function [cerebral performance category (CPC) grades 1-2] and unfavorable neurological function (CPC grades 3-5) at 28 days. The factors with statistical significance in univariate analysis and clinical significance were enrolled in a binary multivariate Logistic regression model to analyze the influencing factors of ROSC and neurological function at 28 days after ROSC. The predictive value of factors influencing neurological function at 28 days was assessed using receiver operator characteristic curve (ROC curve).Results:A total of 277 IHCA-CPR patients were enrolled, of which 230 achieved ROSC (83.0%) and 47 were not achieved (17.0%). Compared with non-ROSC patients, ROSC patients had lower prevalence of cerebrovascular disease history and proportion of adrenaline usage, but a higher proportion of initial shockable rhythms. In the multivariate Logistic regression analysis, it was found that using a bag-mask ventilation+endotracheal intubation (compared with a bag-mask ventilation alone) was beneficial for achieving ROSC in IHCA-CPR patients [odds ratio ( OR) = 2.895, 95% confidence interval (95% CI) was 1.204-6.962, P = 0.018], while a initial non-shockable rhythm was not conducive to achieving ROSC in IHCA-CPR patients ( OR = 0.349, 95% CI was 0.147-0.831, P = 0.017). Among the 230 ROSC patients, 42 had good neurological function at 28 days (18.3%), and 188 had poor neurological function (81.7%). Compared with the patients with good neurological function, the patients with the poor neurological function were older and had a higher prevalence of 1-hour pre-cardiac arrest neurological dysfunction and low perfusion, initial non-shockable rhythms, endotracheal intubation, and usage of adrenaline, vasopressors and sodium bicarbonate, a lower proportion of defibrillation and antiarrhythmic medication usage as well as lower 24-hour post-cardiac arrest Hb levels. The multivariate Logistic regression analysis revealed that female ( OR = 6.449, 95% CI was 1.837-22.642, P = 0.004), older age ( OR = 1.054, 95% CI was 1.017-1.093, P = 0.004), 1-hour pre-cardiac arrest neurological dysfunction ( OR = 25.044, 95% CI was 2.737-229.169, P = 0.004), 1-hour pre-cardiac arrest low perfusion ( OR = 3.880, 95% CI was 1.306-11.524, P = 0.028), endotracheal intubation (compared with a bag-mask ventilation; OR = 8.712, 95% CI was 1.402-54.141, P = 0.020) and face mask+endotracheal intubation during CPR (compared with a bag-mask ventilation; OR = 11.089, 95% CI was 3.482-35.320, P = 0.000), IHCA events > 1 time ( OR = 4.221, 95% CI was 1.249-14.226, P = 0.020) were positively associated with poor neurological function at 28 days, which were independent risk factors those were not conducive to 28-day neurological function recovery after ROSC in IHCA-CPR patients. In contrast, usage of antiarrhythmic medication ( OR = 0.345, 95% CI was 0.134-0.890, P = 0.028) and 24-hour post-cardiac arrest Hb ( OR = 0.983, 95% CI was 0.966-0.999, P = 0.043) were negatively associated with poor neurological function at 28 days, which were protective factors those were beneficial for the recovery of neurological function. ROC curve analysis showed that the area under the ROC curve (AUC) of 24-hour post-cardiac arrest Hb for predicting poor neurological function at 28 days after ROSC in IHCA-CPR patients was 0.659 (95% CI was 0.577-0.742), with a cut-off value of 99.5 g/L (sensitivity was 76.2%, specificity was 57.8%). Conclusions:Defibrillation and tracheal intubation during CPR are crucial for IHCA patients. It was also observed that patients with low Hb (< 99.5 g/L should be of high concern), older age, 1-hour pre-cardiac arrest neurological function and hypoperfusion, and IHCA events > 1 time were significantly related to unfavorable neurological outcome in adult resuscitated patients with IHCA.