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院外心脏停搏后旁观者施救与患者的1年结局研究
Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest


Kristian Kragholm ... 心脑血管疾病 • 2017.05.04
相关阅读
• 肾上腺素治疗院外心脏停搏的随机试验 • 旁观者实施的心肺复苏术和除颤与患者更好的远期结局相关 • 日本的公用除颤设备和院外心脏停搏关系的研究 • 院外心搏骤停患者的早期与晚期心律分析时机的对比

摘要


背景

对于在院外发生心脏停搏的幸存者来说,旁观者介入对其长期功能性结局的影响尚未得到充分研究。

 

方法

我们将丹麦全国院外心脏停搏事件的数据与功能性结局数据关联起来,对于在院外发生心脏停搏后存活至30日的患者,报道了其1年后缺氧性脑损伤、入住疗养院及任何原因死亡的风险。根据旁观者是否实施了心肺复苏术(CPR)或心脏除颤,我们对其风险进行了分析,并评价了旁观者介入及患者结局随时间推移发生的变化。

 

结果

2001~2012年,共有2,855名患者在院外发生心脏停搏并存活至30日。其中共有10.5%的患者发生脑损伤或入住疗养院,9.7%的患者在一年随访期内死亡。在此研究时期内,2,084名患者发生心脏停搏时并无急救医疗服务(EMS)人员现场目睹。这些患者中,旁观者实施CPR的比例从66.7%升至80.6%(P<0.001),旁观者实施心脏除颤的比例从2.1%升至16.8%(P<0.001),脑损伤或疗养院入住率则从10.0%降至7.9%(P<0.001),全因死亡率也从18.0%降至7.6%(P=0.002)。经调整后的分析中,与无旁观者复苏相比较,旁观者CPR伴有显著较低的脑损伤或疗养院入住风险(风险比为0.62;95%置信区间[CI]为0.47~0.82)。除此之外,旁观者CPR也伴有较低的任何原因死亡风险(风险比为0.70;95% CI为0.50~0.99),以及较低的复合终点风险(包括脑损伤、入住疗养院或死亡)(风险比为0.67;95% CI为0.53~0.84)。与无旁观者复苏相比,这些结局的风险在接受了旁观者心脏除颤的患者中甚至更低。

 

结论

在我们的研究中,我们发现,与无旁观者复苏相比,旁观者CPR及心脏除颤伴有显著较低的脑损伤或入住疗养院风险,以及任何原因死亡风险(由TrygFonden及丹麦心脏基金会[Danish Heart Foundation]资助)。





作者信息

Kristian Kragholm, M.D., Ph.D., Mads Wissenberg, M.D., Ph.D., Rikke N. Mortensen, M.Sc., Steen M. Hansen, M.D., Carolina Malta Hansen, M.D., Ph.D., Kristinn Thorsteinsson, M.D., Ph.D., Shahzleen Rajan, M.D., Freddy Lippert, M.D., Fredrik Folke, M.D., Ph.D., Gunnar Gislason, M.D., Ph.D., Lars Køber, M.D., D.Sc., Kirsten Fonager, M.D., Ph.D., Svend E. Jensen, M.D., Ph.D., Thomas A. Gerds, Ph.D., Christian Torp-Pedersen, M.D., D.Sc., and Bodil S. Rasmussen, M.D., Ph.D.
From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen — all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.). Address reprint requests to Dr. Kragholm at the Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark, or at kdks@rn.dk.

 

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