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院外心脏骤停患者的生存预测因素。

Prehospital Predictors of Survival in Patients with Out-of-Hospital Cardiac Arrest.

机构信息

Prehospital Unit, Center for Emergency Medicine, Community Healthcare Center, Cesta Proletarskih Brigad 21, 2000 Maribor, Slovenia.

Emergency Department, University Medical Center Maribor, Ljubljanska ul. 5, 2000 Maribor, Slovenia.

出版信息

Medicina (Kaunas). 2023 Sep 26;59(10):1717. doi: 10.3390/medicina59101717.

Abstract

: Despite advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The aim of our study was to determine the prehospital variables as predictors of survival outcomes in out-of-hospital cardiac arrest (OHCA) victims. : This was a retrospective observational cohort study of OHCA cases. EMS protocols created in accordance with the Utstein style reporting for OHCA, first responder intervention reports, medical dispatch center dispatch protocols and hospital medical reports were all reviewed. Multivariate logistic regression was performed with the following variables: age, gender, witnessed status, location, bystander CPR, first rhythm, and etiology. : A total of 381 interventions with resuscitation attempts were analyzed. In more than half (55%) of them, bystander CPR was performed. Thirty percent of all patients achieved return of spontaneous circulation (ROSC), 22% of those achieved 30-day survival (7% of all OHCA victims), and 73% of those survived with Cerebral Performance Score 1 or 2. The logistic regression model of adjustment confirms that shockable initial rhythm was a predictor of ROSC [OR: 4.5 (95% CI: 2.5-8.1)] and 30-day survival [OR: 9.3 (95% CI: 2.9-29.2)]. Age was also associated (≤67 years) [OR: 3.9 (95% CI: 1.3-11.9)] with better survival. : Elderly patients have a lower survival rate. The occurrence of bystander CPR in cardiac arrest remains alarmingly low. Shockable initial rhythm is associated with a better survival rate and neurological outcome compared with non-shockable rhythm.

摘要

尽管心脏病治疗取得了进展,但经历心搏骤停的患者的预后仍然很差。我们的研究目的是确定院外心脏骤停 (OHCA) 患者的院前变量作为生存结果的预测指标。

这是一项 OHCA 病例的回顾性观察队列研究。审查了符合 Utstein 风格报告的 EMS 协议、第一反应者干预报告、医疗调度中心调度协议和医院医疗报告。使用以下变量进行多变量逻辑回归:年龄、性别、目击状态、位置、旁观者 CPR、第一节律和病因。

共分析了 381 次有复苏尝试的干预措施。在超过一半(55%)的情况下,进行了旁观者 CPR。所有患者中有 30%恢复了自主循环(ROSC),其中 22%在 30 天内存活(所有 OHCA 患者的 7%),其中 73%的患者存活且神经系统表现为 1 或 2 级。调整后的逻辑回归模型证实,可除颤的初始节律是 ROSC [OR:4.5(95%CI:2.5-8.1)]和 30 天存活的预测指标 [OR:9.3(95%CI:2.9-29.2)]。年龄也与(≤67 岁)[OR:3.9(95%CI:1.3-11.9)]的生存改善相关。

老年患者的存活率较低。心脏骤停时旁观者 CPR 的发生率仍然令人震惊地低。与非可除颤节律相比,可除颤的初始节律与更高的生存率和神经功能结局相关。

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