呼吸心脏骤停患者心肺复苏失败的影响因素分析

Influencing factors for failed cardiopulmonary resuscitation in patients with respiratory and cardiac arrest

  • 摘要:
    目的 探讨呼吸心脏骤停患者心肺复苏失败的影响因素。
    方法 回顾性分析204例呼吸心脏骤停患者的临床资料,所有患者均行心肺复苏治疗,根据心肺复苏效果分为成功组与失败组。开展基于匹配设计的病例对照研究,以性别、年龄、体质量指数及是否合并高血压、高脂血症、糖尿病为协变量,将成功组与失败组按1∶ 2比例进行匹配。采用Logistic回归分析法探讨呼吸心脏骤停患者心肺复苏失败的影响因素。
    结果 204例患者中,心肺复苏成功65例(占31.86%), 纳入成功组; 心肺复苏失败139例(68.14%),纳入失败组。经1∶ 2比例匹配设计后,最终成功组62例、失败组124例纳入研究。多因素Logistic回归分析结果显示,呼吸心脏骤停病因为心血管疾病、心肺复苏地点为院外、发病至心肺复苏开始时间长及肾上腺素用量大是心肺复苏失败的独立危险因素(P < 0.05), 呼吸心脏骤停时联用气囊面罩与气管插管、心肺复苏持续时间长及电击除颤是心肺复苏成功的独立保护因素(P < 0.05)。
    结论 心血管疾病、院外心肺复苏、发病至心肺复苏开始时间长及肾上腺素用量大是呼吸心脏骤停患者心肺复苏失败的危险因素,呼吸心脏骤停时联用气囊面罩与气管插管、延长心肺复苏持续时间及电击除颤是心肺复苏成功的保护因素。基于匹配设计的病例对照研究方法可减少混杂因素干扰,保证结果的可信度,能为心肺复苏干预方案的制订提供可靠依据。

     

    Abstract:
    Objective To investigate influencing factors for failed cardiopulmonary resuscitation (CPR) in patients with respiratory and cardiac arrest.
    Methods A retrospective analysis was conducted on the clinical data of 204 patients with respiratory and cardiac arrest. All patients underwent CPR treatment and were divided into success group and failure group based on the CPR outcome. A matched case-control study based on matching design was carried out. The success and failure groups were matched at a ratio of 1 to 2 using gender, age, body mass index (BMI), and the presence or absence of hypertension, hyperlipidemia, and diabetes as covariates. Logistic regression analysis was employed to explore the influencing factors for failed CPR in patients with respiratory and cardiac arrest.
    Results Among the 204 patients, 65 (31.86%) had successful CPR and were included in success group, while 139 (68.14%) had failed CPR and were included in failure group. After a ratio of 1 to 2 matching design, 62 patients in the success group and 124 patients in the failure group were finally included in the study. Multivariate logistic regression analysis revealed that cardiovascular disease as the cause of respiratory and cardiac arrest, CPR performed outside the hospital, a long time interval from the onset of the condition to the initiation of CPR, and a large dose of epinephrine were independent risk factors for failed CPR (P < 0.05). In contrast, the combined use of a bag-mask device and endotracheal intubation during respiratory and cardiac arrest, a prolonged duration of CPR, and electrical defibrillation were independent protective factors for successful CPR (P < 0.05).
    Conclusion Cardiovascular disease, out-of-hospital CPR, a long time interval from the onset of the condition to the initiation of CPR, and a large dose of epinephrine are risk factors for failed CPR in patients with respiratory and cardiac arrest. The combined use of a bag-mask device and endotracheal intubation during respiratory and cardiac arrest, prolonging the duration of CPR, and electrical defibrillation are protective factors for successful CPR. The matched case-control study method based on a matching design can reduce the interference of confounding factors, ensure the reliability of the results, and provide a reliable basis for the formulation of CPR intervention protocols.

     

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