Clinical Antecedents to Cardiopulmonary Resuscitation in the Medical Intensive Care Unit: A Retrospective Study

內科加護病房病人接受心肺復甦術前臨床表徵之回溯性研究

周建宏(Chien-Hong Chou) ； 鄭之勛(Jih-Shuin Jerng) ； 石崇良(Chong-Liang Shih) ； 余忠仁(Chong-Jen Yu) ； 楊泮池(Pan-Chyr Yang)

《胸腔醫學》 21卷3期 (2006/06) Pp. 239-246

https://doi.org/10.29806/TM.200606.0003

摘要

背景：本篇報告探討在加護病房中發生心肺停止前的臨床表徵。
方法：本研究收集從2003年1月至2004年12月在內科加護病房中接受心肺復甦述的病人，探討相關在接受心肺復甦術後能恢復自主循環的因子。
結果：共收集45位病人（佔加護病房總住院人數1.2%）接受心肺復甦術，其中27人(60%)成功恢復自主循環，但僅4人(8.9%)存活出院。評估心肺停止前病人情況發現38人(84%)在心肺停止前的8小時內曾觀察到臨床情況惡化，而17人(38%)在心肺停止前的24小時內曾觀察到臨床情況惡化。病患原有疾病仍以心臟血管及呼吸道方面為主。在發生心肺停止之前以低血壓為最常見的情況。心血管方面異常(RR=0.182, p=0.018)以及預期發生之急救(RR=0.125, p=0.009)是導致自主循環恢復機會降低之主要因素。
結論：在內科加護病房發生心肺停止時，接受急救之預後不佳。預期發生心肺停止並接受急救之病人，以及有前驅心臟血管異常事件的病人，接受心肺復甦術的成功率較低。

關鍵字

心肺復甦術 ； 加護病房

並列摘要

Background: The clinical antecedents of cardiopulmonary arrest in the intensive care unit have not been well defined yet.
Methods: We retrospectively reviewed those patients who received cardiopulmonary resuscitation in the medical intensive care unit over a 2-year period. We evaluated a number of pre-arrest conditions to determine if the outcome after cardiopulmonary resuscitation was influenced by any of these parameters.
Results: A total of 45 patients (1.2% of medical intensive care unit admissions) were identified. Among them, 27 (60%) were successfully resuscitated with recovery of spontaneous circulation, but only 4 patients (8.9%) survived to hospital discharge. A total of 38 (84%) and 17 (38%) of the patients had documented observations of clinical deterioration within 8 and 24 hours of arrest, respectively. Patients developing arrest in the medical intensive care unit have predominantly respiratory and cardiovascular derangements in the underlying disease. Arrest was frequently preceded by a clinical deterioration involving hypotension. Antecedent cardiovascular events (RR=0.182, p=0.018), including shock, and expected arrests (RR=0.125, p=0.009), were associated with a worse chance of recovery of spontaneous circulation.
Conclusion: Patients receiving cardiopulmonary resuscitation have a poor outcome. Expected arrests and antecedent cardiovascular events are associated with a reduced chance of successful resuscitation.

並列關鍵字

cardiopulmonary resuscitation ； intensive care unit