文章摘要
早期气管插管对成人院内心搏骤停患者自主循环恢复及存活出院率的影响
Early endotracheal intubation affects the return of spontaneous circulation and survival rate in adult patients with in-hospital cardiac arrest
投稿时间：2023-10-25  
DOI：10.3969/j.issn.1000-0399.2024.07.006
中文关键词: 院内心搏骤停  气管插管  自主循环恢复  预后  回顾性队列研究
英文关键词: In-hospital cardiac arrest  Endotracheal intubation  Return of spontaneous circulation  Prognosis  Retrospective cohort study
基金项目:中央财政专项经费（编号：2018FY100600）
作者单位E-mail
丁智颖 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
朱甜甜 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
赵勇 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
张阿芳 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
包华瑞 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
潘琳琳 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
何媛媛 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
方芳 230022 安徽合肥 安徽医科大学第一附属医院急诊科  
张泓 230022 安徽合肥 安徽医科大学第一附属医院急诊科 zhanghong20070703@163.com 
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中文摘要:
      目的 分析早期气管插管对成人院内心搏骤停（IHCA）患者自主循环恢复（ROSC）及存活出院率的影响。方法 选取 2019 年 11 月至 2020 年 10 月在安徽医科大学第一附属医院发生院内心搏骤停的 423 例患者，根据抢救期间是否行气管插管分为气管插管组（263 例）和非气管插管组（160 例），其中气管插管组又分为 15 分钟内气管插管组（118 例）和超过 15 分钟气管插管组（145例）。采用单因素比较和多因素 logistic 回归分析 15 分钟内气管插管组、超过 15 分钟气管插管组与非气管插管组患者 ROSC 和存活出院率的差异及相关影响因素。结果 15 分钟内气管插管组 118 例患者中 ROSC 的患者为 36 例，恢复率为 30.51%；超过 15 分钟气管插管组 145 例患者中 ROSC 的患者为 43 例，恢复率为 29.65%；而非气管插管组 160 例患者中 ROSC 的患者为 30 例，恢复率为 18.75%，15分钟内气管插管组、超过 15 分钟气管插管组与非气管插管组患者恢复率比较，差异均有统计学意义（P<0.05）。15 分钟内气管插管组118 例患者中存活出院为 55 例，存活出院率为 46.61%；超过 15 分钟气管插管组 145 例患者中存活出院为 48 例，存活出院率为 33.10%；而非气管插管组 160 例患者中存活出院为 49 例，存活出院率为 30.63%，15 分钟内气管插管组与非气管插管组患者存活出院率比较，差异有统计学意义（P<0.05）。多因素 logistic 回归分析显示患者的初始心率、是否有旁观者、15 分钟内气管插管、长期居住地、有无入住 ICU、是否存在低血压/休克、是否存在严重创伤，均是影响患者存活出院率的因素。结论 气管插管时机影响成人 IHCA 患者ROSC 及存活出院率，其中 15 分钟内气管插管组的 ROSC 率和存活出院率均高于非气管插管组。
英文摘要:
      Objective To analyze the effects of early endotracheal intubation on the return of spontaneous circulation (ROSC) and survival rate in adult patients with cardiac arrest in hospital. Methods A total of 423 patients with cardiac arrest in the First Affiliated Hospital of Anhui Medical University from November 2019 to October 2020 were divided into the endotracheal intubation group (263 cases) and nonendotracheal intubation group (160 cases). The endotracheal intubation group was also divided into the endotracheal intubation group within 15 minutes (118 cases) and the endotracheal intubation group more than 15 minutes (145 cases). Univariate comparison and multivariate logistic regression were used to analyze the differences in ROSC, survival rate and related influencing factors between the tracheal intubation group and non-tracheal intubation group. Results Altogether 36 of 118 patients in the endotracheal intubation group within 15 minutes achieved ROSC, and the recovery rate was 30.51%; 43 of 145 patients in the endotracheal intubation group within more than 15 minutes achieved ROSC, and the recovery rate was 29.65%. In comparison, 30 of 160 patients in the non-endotracheal intubation group achieved ROSC, with a recovery rate of 18.75%. The difference between the tracheal intubation groups within 15 minutes, endotracheal intubation group more than 15 minutes and non-tracheal intubation group were statistically significant (P<0.05). In the tracheal intubation group within 15 minutes, 55 of the 118 patients survived, with a survival rate of 46.61%; 48 of 145 patients in the endotracheal intubation group more than 15 minutes survived, with a survival rate of 33.10%. Among the 160 patients in the non-tracheal intubation group, 49 patients survived, with a survival rate of 30.63%. There was significant difference between the tracheal intubation group within 15 minutes and non-tracheal intubation group (P<0.05). Multivariate logistic regression analysis showed that initial heart rate, presence of bystanders, tracheal intubation group within 15 minutes, residence, ICU admission, hypotension/shock, and severe trauma were all factors affecting the survival rate of patients. Conclusion Early endotracheal intubation affects ROSC and survival rate of IHCA adult patients. The ROSC rate and survival rate in the endotracheal intubation group within 15 minutes were better than those in the non-endotracheal intubation group.
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