院内心脏骤停:患者特征和影响生存和神经预后的因素

Y. Cho
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摘要

目的:了解院内心脏骤停(IHCA)患者的特点,以及影响其存活至出院和神经系统预后良好的因素。方法:对2011年1月1日至2013年12月31日在顺天香大学首尔医院发生IHCA的患者进行调查。他们被分为生存组和非生存组。比较两组患者的年龄、性别、合并症、骤停时间、骤停地点、目击骤停、监测、骤停原因、骤停节律、心肺复苏时间等特征。此外,我们通过多变量逻辑回归分析评估了与出院存活率和良好神经系统预后相关的因素。结果:共观察IHCA患者453例。生存组的合并症包括神经系统疾病(P < 0.001)、心律失常(P = 0.001)、心肌梗死(P = 0.032)、肺炎(P = 0.016)。其他特征包括白天心脏骤停(P = 0.032)、心源性骤停原因(P = 0.019)和CPR持续时间< 15分钟(P < 0.001)。与存活至出院相关的因素包括共病性神经系统疾病(优势比[OR], 2.191;P = 0.031),心律失常(OR, 3.027;P = 0.009),肺炎(OR, 3.243;P = 0.002), CPR持续时间< 15分钟(OR, 9.638;P < 0.001)。影响神经系统预后良好的因素包括:年龄< 65岁(OR, 3.158;P = 0.007),合并症为心律失常(OR, 4.921;P = 0.001),肺炎(OR, 4.551;P = 0.001)、低血压(OR, 4.264;P = 0.021), CPR持续时间< 15分钟(OR, 6.652;P = 0.001)。结论:影响IHCA患者存活至出院和神经系统预后良好的因素包括合并症、骤停原因和CPR持续时间。
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In-Hospital Cardiac Arrest: Patient Characteristics and Factors Influencing Survival and Neurologic Outcomes
Objective: We aimed to determine the characteristics of in-hospital cardiac arrest (IHCA) patients, as well as the factors influencing survival to discharge and good neurologic outcome.Methods: We examined patients who experienced IHCA from January 1, 2011, to December 31, 2013, in Soonchunhyang University Seoul Hospital. They were divided into a survival group and non-survival group. The patient characteristics, including age, sex, comorbid disease, arrest time, arrest location, witnessed arrest, monitoring, arrest cause, arrest rhythm, and cardiopulmonary resuscitation (CPR) duration, were compared between the groups. Moreover, we assessed the factors associated with survival to discharge and good neurologic outcomes by using multivariate logistic regression analysis.Results: In total, 453 patients of IHCA were observed. The comorbidities in the survival group included neurologic disease (P < 0.001), arrhythmia (P = 0.001), and myocardial infarction (P = 0.032), pneumonia (P = 0.016). Other characteristics included cardiac arrest at daytime (P = 0.032), cardiogenic arrest cause (P = 0.019), and CPR duration < 15 minutes (P < 0.001). The factors associated with survival to discharge included comorbid neurologic disease (odds ratio [OR], 2.191; P = 0.031), arrhythmia (OR, 3.027; P = 0.009), pneumonia (OR, 3.243; P = 0.002), and CPR duration < 15 minutes (OR, 9.638; P < 0.001). The factors influencing good neurologic outcomes included age < 65 years (OR, 3.158; P = 0.007), comorbid disease as arrhythmia (OR, 4.921; P = 0.001), pneumonia (OR, 4.551; P = 0.001), hypotension (OR, 4.264; P = 0.021), and CPR duration < 15 minutes (OR, 6.652; P = 0.001).Conclusion: The factors influencing survival to discharge and good neurologic outcomes among IHCA patients included comorbidities, arrest cause, and CPR duration.
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