| Objective To learn about the distribution of initial rhythm of patients with cardiac arrest and the survival condition of patients after restoration of spontaneous circulation(ROSC)and general clinical characteristics,to investigate the risk factors for initial rhythm of patients with cardiac arrest for a non-shockable rhythm and factors affecting the prognosis of patients with ROSC,so as to provide preliminary theoretical basis for prevention and treatment of the disease.Method 1.By set of clinical cases observation table,we retrospectively analazed 232 cases of cardiac arrest patients occurred in emergency department and intensive care unit(ICU)of PLA Army General Hospital?First Affiliated Hospital of PLA General Hospitai?Beijing Friendship Hospital,Captial Medical University from April 2014 to April 2016.According to the patient's initial rhythm whether could defibrillation,which can be divided into shockable rhythm group and non-shockable rhythm group,compared two groups of patients' clinical data with gender,age,cause of cardiac arrest,basic diseases,a history of invasive cardiovascular examination and treatment,cardiovascular prescription medication history etc,through the Logistic regression analysis to screening out the risk factors for patients with cardiac arrest occurred non-shockable rhythm.2.We enrolled 63 cases of ROSC patients after positive treatment of 232 cardiac arrest patients.Both of them were treated by circulation,respiratory support,correct electrolyte disorder,infection control and other comprehensive treatment,at the same time,record the clinical datas: including age,gender,basic diseases,cardiovascular drugs prescription medication history and so on;CPR datas: initial rhythm,ROSC time,establishment of artificial airway time and so on;critical scores' datas :Glasgow Coma Scale(GCS),acute physiology and chronic health evaluation(APACHE II)and so on;survival datas: we observed from restore spontaneous circulation time follow-up to 28 days to the end.The 16 factors which possibly predictor outcomes of CA after ROSC were analysed by single factor analysis and multivariate analysis respectively through Cox proportional hazards regression model,screening out the independent prognostic factors for ROSC patients.Result 1.In our study,the average age of the patients with cardiac arrest was(61.19 ±17.25)years old,men and women respectively constituted 56.9%?43.1%,included shock rhythm of 32 cases(13.8%);non-shock rhythm of 200 cases(86.2%).The primary causes of cardiac arrest was sudden cardiac death occupyed 35.8% in total patients;91 cases(39.2%)had coronary heart disease which was located in the first place of basic diseases distribution,beta blocker was the most widely used in the history of cardiovascular medicine prescription drugs.There were 88 patients(37.9%)taking beta blockers according to the rules.The single factor analysis results showed that the age,sudden cardiac death,severe infection,coronary heart disease,chronic obstructive pulmonary disease,beta blockers medication history in two groups of patients had significant difference(P < 0.05);Logistic regression analysis results showed that therisk factors for non-shock rhythm included severe infection,chronic obstructive pulmonary disease history,history of beta blockers medication and risk factors for shock rhythm was coronary heart disease.2.There were a total of 68 cases that restore spontaneous circulation and survival of 12 hours or more from 232 patients of cardiac arrest after first cardiopulmonary resuscitation(CPR),the success rate of recovery was 29.3%,excluding more than two times CPR after admitted to hospital and information was not completed or gave up treatment halfway.Ultimately we enrolled a total of 63 research objects,31 cases of men;32 cases of women;average age for(56.95 + 14.70)years old;There were a total of 14 cases of survival for 28 days,accounted for 22.2% of the patients with ROSC;Cox regression model analysis results show that adrenaline dosage,recovery time of spontaneous circulation,Full Outline of Unresponsiveness,and initial rhythm were independent factors affecting the prognosis of patients with ROSC.Conclusion 1.The incidence of initial rhythm that was shock rhythm in Adult cardiac arrest patients was 13.8%,and coronary heart disease increased availability of shock rhythm risk,the initial rhythm in these patients were more performances for shock rhythm,and the incidence of initial rhythm that showed non-shock rhythm was 86.2%,severe infection,chronic obstructive pulmonary disease,and beta blockers medication history were high risk factors for non-shock rhythm occurs.2.Independent influence factors of the prognosis for adult ROSC patients were dosage of adrenaline,recovery time of spontaneous circulation,Full Outline of Unresponsiveness,the initial rhythm;Dose of epinephrine,recovery time ofspontaneous circulation are positively related to mortality of the patients of CA after ROSC,Full Outline of Unresponsiveness is negatively correlated with mortality,and there is relative higher mortality in the patients of non-shockable rhythm than that of shockable rhythm. |
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