院前心搏骤停患者自主循环恢复实现及神经功能恢复的影响因素

doi:10.3969/j.issn.1671-7171.2025.09.032

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摘要【目的】探讨院前心搏骤停(OHCA)患者自主循环恢复(ROSC)实现及神经功能恢复的影响因素。【方法】收集90例OHCA患者的临床资料。比较ROSC与非ROSC患者的临床特征,并分析ROSC患者28 d内神经功能恢复不良的危险因素。【结果】90例患者中,ROSC为69例,ROSC未恢复者21例。ROSC组初始可除颤心律比例和使用肾上腺素比例高于非ROSC组(P<0.05),急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分低于非ROSC组(P<0.05)。Logistic多因素回归分析显示,初始可除颤心律和APACHEⅡ评分为OHCA患者实现ROSC的独立影响因素(P<0.05)。69例ROSC患者28 d后神经功能良好者22例(A组),而神经功能不良者47例(B组)。A组初始可除颤心律比例和使用抗心律失常药物比例、血红蛋白(Hb)高于B组(P<0.05),使用肾上腺素、升压药、碳酸氢钠比例低于B组(P<0.05)。多因素Logistic回归分析显示,初始可除颤心律、Hb水平为ROSC患者神经功能不良的独立影响因素(P<0.05)。【结论】OHCA患者心肺复苏后的预后受多个因素影响,ROSC的主要影响因素为初始可除颤心律和APACHEⅡ评分,而神经功能恢复不良的独立危险因素为初始可除颤心律和Hb水平。

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	杨鑫涛
	代玉静
	李苏慧
	卫凯锋

关键词 ：猝死, 心脏, 神经康复, 自主循环恢复, 影响因素分析

Abstract：【Objective】 To investigate the factors influencing the return of spontaneous circulation(ROSC) and neurological recovery in patients with out-of-hospital cardiac arrest(OHCA).【Methods】 Clinical data of 90 OHCA patients were collected. Clinical characteristics were compared between the ROSC and non-ROSC groups, and risk factors for poor neurological recovery within 28 days were analyzed among ROSC patients.【Results】 Among the 90 patients, 69 achieved ROSC and 21 did not. The ROSC group had a higher proportion of initial shockable rhythms and epinephrine use, and a lower Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score compared to the non-ROSC group(P<0.05). Multivariate logistic regression analysis showed that initial shockable rhythm and APACHEⅡ score were independent factors associated with ROSC(P<0.05). Among the 69 patients who achieved ROSC, 22 had good neurological outcomes(Group A) and 47 had poor neurological outcomes(Group B) after 28 days. Group A had higher proportions of initial shockable rhythms, antiarrhythmic drug use, and hemoglobin(Hb) level compared to Group B(P<0.05), while the use of epinephrine, vasopressors, and sodium bicarbonate in Group A was lower than those in Group B(P<0.05). Multivariate logistic regression analysis identified initial shockable rhythm and Hb level as independent risk factors for poor neurological outcomes in ROSC patients(P<0.05).【Conclusion】 The prognosis of OHCA patients after cardiopulmonary resuscitation is influenced by multiple factors. The main factors affecting ROSC are initial shockable rhythm and APACHEⅡ score, while independent risk factors for poor neurological recovery include initial shockable rhythm and hemoglobin level.

Key words： Death, Sudden, Cardiac Neurological Rehabilitation Return of Spontaneous Circulation Root Cause Analysis

收稿日期: 2025-05-29

中图分类号:

R541.78

引用本文:

杨鑫涛, 代玉静, 李苏慧, 卫凯锋. 院前心搏骤停患者自主循环恢复实现及神经功能恢复的影响因素[J]. 医学临床研究, 2025, 42(9): 1601-1604.
YANG Xintao, DAI Yujing, LI Suhui, et al. Influencing Factors of Return of Spontaneous Circulation and Neurological Recovery in Out-of-Hospital Cardiac Arrest Patients. JOURNAL OF CLINICAL RESEARCH, 2025, 42(9): 1601-1604.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2025.09.032 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2025/V42/I9/1601

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