心肺复苏患者临床特点及自主循环复苏成功率的临床分析

摘要

目的：分析心肺复苏（ CPR）患者临床特点及自主循环复苏成功率。方法回顾性分析2012年2月至2014年3月沈阳二四二医院行现场抢救的194例患者的临床资料，包括性别、年龄、复苏方式、救治时间、开始复苏时间、复苏持续时间等，采用急性生理学与慢性健康状况评分Ⅱ（ APACHEⅡ）系统对复苏成功患者进行预后评价，记录住院时间并随访复苏成功患者全身炎症反应综合征和多器官功能障碍综合征发生率。结果复苏方式：气管插管通气复苏32例，面罩-气囊通气复苏38例，口对口人工呼吸复苏21例。面罩-气囊通气组自主循环成功复苏高于插管通气组[50.0％（19／38）比15.6％（5／32）]，面罩-气囊通气组复苏成功患者 APACHEⅡ评分低于气管插管通气组、住院时间短于气管插管通气组[（21±7）分比（32±9）分，（23±7） d比（36±9） d]，差异有统计学意义（P＜0.05）。呼吸心搏骤停＜6 min组实施CPR者的自主循环复苏成功率高于呼吸心搏骤停6～10 min组[54.4％（25／46）比12.5％（3／24）]，呼吸心搏骤停6～10 min组和呼吸心搏骤停＞10 min组复苏成功患者APACHEⅡ评分高于呼吸心搏骤停＜6 min组、住院时间长于呼吸心搏骤停＜6 min组[（29±6）分、（37±8）分比（20±5）分，（31±7） d、（35±9） d比（23±6） d]，差异有统计学意义（P＜0.05）。 CPR持续20～30 min组CPR最终成功率高于CPR持续＜10 min组[51.4％（19／37）比25.8％（8／31）]，CPR持续20～30 min复苏成功患者APACHEⅡ评分低于CPR持续＜10 min组、住院时间短于CPR持续＜10 min组[（23±8）分比（28±9）分，（22±5） d比（30±7） d]，差异有统计学意义（P＜0.05）。结论使用面罩-气囊通气、在6 min 内实施 CPR、持续CPR 20～30 min 时可提高自主循环复苏成功率和患者预后效果，缩短住院时间，并且应积极预防复苏后并发症的发生。%Objective To explore the clinical features of the patients with cardiopulmonary resuscitation and the spontaneous circulation recovery success rate.Methods Retrospective study on 194 patients who received on-site emergency rescue in Shenyang 242 Hospital during Feb.2012 and Mar.2013 was done, including age,gender,recovery mode,treatment time,recovery starting time, recovery lasting time were recor-ded as basic clinical data,to analyze the relationship between respiratory mode,recovery starting time,recov-ery lasting time and spontaneous circulation recovery success.The acute physiology and chronic health evalu-ation( APACHE Ⅱ) scoring system was adopted for prognostic evaluation of successfully resuscitated patients,the hospitalized time was recorded ,and the systemic inflammatory response syndrome incidence and multiple organ dysfunction syndrome incidence were recorded during the follow-up.Results Altogether 32 cases used tracheal intubation ventilation,38 cases used mask-balloon ventilation,21 cases used mouth to mouth resuscitation.Successful recovery of spontaneous circulation in mask-balloon ventilation group was higher than intubation ventilation group [ 50.0%( 19/38 ) vs 15.6%( 5/32 ) ] , mask-balloon ventilation group successfully resuscitated patients APACHEⅡ rates, length of stay were less than endotracheal tube ventilation group[(21 ±7) scores vs (32 ±9) scores,(23 ±7) d vs (36 ±9) d],the differences were sta-tistically significant(P<0.05).CPR′s success rate of spontaneous circulation for patients with respiratory and cardiac arrest <6 min was higher than patients with cardiac arrest of 6-10 min [ 54.4%( 25/46 ) vs 12.5%(3/24)],APACHEⅡ scores of successfully resuscitated patients with respiratory and cardiac arrest 6-10 min and respiratory and cardiac arrest >10 min were higher and hospital stay time was longer than patients with respiratory and cardiac arrest <6 min [(29 ±6) scores, (37 ±8) scores vs (20 ±5) scores, (31 ±7) d, (35 ±9) d vs (23 ±6) d], the differences were statistically significant(P<0.05).The ultimate success rate of CPR of 20-30 min was higher than CPR duration <10 min [ 51.4%( 19/37 ) vs 25.8%( 8/31)],APACHEⅡscore of CPR of 20-30 min was lower than CPR duration<10 min,hospital stay was less than CPR <10 min [(23 ±8) scores vs (28 ±9) scores, (22 ±5) d vs (30 ±7) d],the differences were statisti-cally significant ( P <0.05 ) .Conclusion The mask-balloon ventilation method , CPR administered within 6 min of the arrest,CPR continuously for 20-30 min can improve the success recovery rate of spontaneous circu-lation and the prognosis and shorten the hospital stay ,and active prevention of the complications after recovery should be done.