Dunn H M, McComb J M, MacKenzie G, Adgey A A
Am Heart J. 1986 Oct;112(4):745-51. doi: 10.1016/0002-8703(86)90469-2.
In 125 consecutive patients with 173 arrests due to ventricular fibrillation, 53 survived to leave hospital. At the initial arrest and using univariate analysis, those who had primary ventricular fibrillation, had ventricular fibrillation less than 24 hours from the onset of symptoms, received the first DC shock less than 1 minute after the onset of ventricular fibrillation, who required less than 4 shocks to terminate the ventricular fibrillation, whose first established rhythm within the first minute of correction of ventricular fibrillation was atrial fibrillation, sinus rhythm or paced rhythm, or who were not receiving prior antiarrhythmic agents had a significantly improved survival to leave hospital (p less than 0.05). To predict survival to leave hospital using discriminant function analysis, the most significant factors ranking in order of importance at the time of the initial arrest were: less than or equal to 5 shocks to correct ventricular fibrillation, no prior antiarrhythmic therapy, primary ventricular fibrillation, and time from onset of ventricular fibrillation to first shock less than 1 minute. For the last arrest, the most significant factors were: no prior cardiac arrest, less than or equal to 5 shocks to correct ventricular fibrillation, no prior antiarrhythmic therapy, and primary ventricular fibrillation. The most significant factors measured at the time of the last arrest provided a better prediction of survival to leave hospital (sensitivity 77%, specificity 75%) than did similarly defined factors for the initial arrest (sensitivity 59%, specificity 89%).
在125例因心室颤动导致173次心脏骤停的连续患者中,53例存活出院。在初次心脏骤停时采用单因素分析,那些发生原发性心室颤动、症状发作后24小时内发生心室颤动、心室颤动发作后1分钟内接受首次直流电除颤、终止心室颤动所需除颤次数少于4次、心室颤动纠正后第一分钟内首次确立的节律为心房颤动、窦性心律或起搏心律,或未接受过抗心律失常药物治疗的患者,其存活出院率显著提高(p<0.05)。为了使用判别函数分析预测存活出院情况,初次心脏骤停时按重要性排序最重要的因素依次为:纠正心室颤动所需除颤次数小于或等于5次、未接受过抗心律失常治疗、原发性心室颤动、以及心室颤动发作至首次除颤的时间小于1分钟。对于末次心脏骤停,最重要的因素为:既往无心脏骤停、纠正心室颤动所需除颤次数小于或等于5次、未接受过抗心律失常治疗、以及原发性心室颤动。末次心脏骤停时测量的最重要因素对存活出院的预测效果(敏感性77%,特异性75%)优于初次心脏骤停时类似定义的因素(敏感性59%,特异性89%)。