Schultz S C, Cullinane D C, Pasquale M D, Magnant C, Evans S R
Department of Surgery, Georgetown University Hospital, Washington, DC 20007, USA.
Resuscitation. 1996 Nov;33(1):13-7. doi: 10.1016/s0300-9572(96)00986-0.
On the average, 10-15% of patients who undergo cardiopulmonary resuscitation (CPR) following a cardiopulmonary arrest in the hospital environment will survive to be discharged. The purpose of this study was to determine objective factors influencing patient outcome after CPR to determine who should be resuscitated and when to end CPR efforts. The records of 266 patients who underwent in-hospital CPR over a 3-year period were retrospectively analyzed with regard to age, gender, co-morbid conditions, setting of arrest, duration of resuscitation, initial pH and PO2 during resuscitation, and outcome of resuscitative efforts. Twenty-four (9%) patients survived to be discharged from hospital. Eighty-seven (33%) patients arrested in the intensive care unit, 77 (29%) on the ward, 91 (34%) in the emergency room, six (2%) in the cardiac catheterization laboratory and five (2%) in the operating room. There was no significant difference in survival based on location of arrest. Factors associated with a poor prognosis included age greater than 60, co-morbid disease (i.e. pneumonia, sepsis, renal failure, heart disease, etc.), an initial PO2 < 50 mmHg and CPR efforts extending beyond 10 min. Based on this data, guidelines regarding initiation and termination of CPR should be instituted in light of poor outcome in patients over 60 years of age with co-morbid conditions, specifically after 10 min of CPR.
在医院环境中，心脏骤停后接受心肺复苏（CPR）的患者平均有10% - 15%能够存活至出院。本研究的目的是确定影响心肺复苏后患者预后的客观因素，以确定哪些患者应接受复苏以及何时终止心肺复苏努力。回顾性分析了266例在3年期间接受院内心肺复苏患者的记录，内容包括年龄、性别、合并疾病、骤停地点、复苏持续时间、复苏期间的初始pH值和PO2以及复苏结果。24例（9%）患者存活至出院。87例（33%）患者在重症监护病房发生骤停，77例（29%）在病房，91例（34%）在急诊室，6例（2%）在心脏导管实验室，5例（2%）在手术室。基于骤停地点的生存率无显著差异。与预后不良相关的因素包括年龄大于60岁、合并疾病（如肺炎、败血症、肾衰竭、心脏病等）、初始PO2 < 50 mmHg以及心肺复苏努力超过10分钟。基于这些数据，对于60岁以上合并疾病的患者，尤其是在心肺复苏10分钟后，鉴于预后不良，应制定关于心肺复苏启动和终止的指南。
