The Clinical Characteristics and Outcomes of In-Hospital Cardiac Arrest Patients with Successful Resuscitation in a Teaching Hospital in Central Taiwan

台灣中部某醫院到院後心跳停止急救成功病人的臨床特性及預後之探討

許宗鴻(Choon-Hoon Hii) ； 簡旭霄(Hsun-Hsiao Chien) ； 阮祺文(Chi-Wen Juan)

《中華民國急救加護醫學會雜誌》 24卷3期 (2013/09) Pp. 77-88

摘要

研究背景：院後心跳停止病人的結果是反映醫院之醫療處置能力及緊急醫療品質的重要指標。為了解院後心跳停止且急救成功病人之臨床特性及相關的結果，本論文將針對這項目做深入的探討。研究方法：本研究收集2010年1月1日至2012年12月31日在中台灣某區域教學醫院，具87床之加護病房，收集年齡超過18歲以上的院後心跳停止病人。收集相關資料來比較院後心跳停止且急救成功病人其死亡與存活病患的臨床特性及相關結果。研究結果：在此一研究期間，共有301位院後心跳停止且急救成功的病人被收入。其死亡率為66.1%（N=199）；其中62.3%（N=124）死亡個案在24小時內死亡。死亡的個案有較高的年齡（72.1 ± 15.6 vs. 67.6 ± 15.9，p=0.019），APACHE II（32.1 ± 8.9 vs. 19.3 ± 8.5，p＜0.001），TISS（34.1 ± 8.9 vs. 29.1 ± 8.9，p ＜0.001），CCI（3.2 ± 1.5 vs. 2.6 ± 1.6，p=0.001）。然而其GCS分數卻是較低（6.4 ± 5.1 vs. 9.8 ± 4.7，p＜0.001），較短的加護病房住院天數（4.9 ± 8.2 vs. 16.1 ± 12.3，p＜0.001），較短的住院總天數（9.6 ± 19.3 vs. 40.7 ± 35.4，p＜0.001）及較少的醫療費用（149358 ± 274827 vs. 425781 ± 384156，p＜0.001）。24小時就死亡的個案有較高的APACHE II（34.9 ± 8.9 vs. 30.3 ± 8.4，p＜0.001）；且93.5%（N=116）為內科患者。至於存活個案，18.9%（N=57）的CPCS為1或2；15%（N=45）的CPCS大於2。對於CPCS大於2的存活組，有較高的年齡，APACHE II，CCI及醫療費用；較長的加護病房及住院總天數和較低的GCS分數。多變項分析顯示院後心跳停止（IHCA）而急救成功至存活出院的年齡（勝算比為2.32; 95%信賴區間為1.58-6.21; p=0.047）；APACHE II（勝算比為1.46; 95%信賴區間為1.04-2.08; p=0.06）及GCS分數（勝算比為0.72；95%信賴區間為0.39-1.46; p=0.039）為存活者神經學結果較差的危險相關因子。研究結論：院後心跳停止（IHCA）而急救成功至存活出院且有良好結果的個案比率少於五分之一。患者的死亡及結果跟疾病嚴重指標相關。降低院後心跳停止的發生，提升存活率及有較好的經學結果為未來的策略重點。

關鍵字

到院後心跳停止 ； 結果

並列摘要

Background: As the outcomes of in-hospital cardiac arrest (IHCA) have been identified as a more refined measure of institutional readiness and effectiveness in the treatment of IHCA. The purpose of this study was to delineate the clinical characteristics and outcomes of IHCA patients with successful cardiopulmonary resuscitation (CPR). Materials and Methods: The study period was from January 1, 2010 to December 31, 2012. Adult patients (age ≥18) with successful CPR after IHCA were included for analysis. Data from a prospectively maintained database of IHCA in a secondary teaching referral hospital were reviewed and analyzed. Results: 301 IHCA patients were included during the study period. The mortality rate among IHCA patients was 66.1% (N=199), with 62.3% (N=124) of the non-survivors died within 24 hours. The non-survivors were older (72.1 ± 15.6 vs. 67.6 ± 15.9, p=0.019) and had significantly higher Acute physiology and chronic health evaluation II (APACHE II) score (32.1 ± 8.9 vs. 19.3 ± 8.5, p＜0.001), Therapeutic Intervention Scoring System (TISS) score (34.1 ± 8.9 vs. 29.1 ± 8.9, p ＜0.001), Charlson Comorbidity Index (CCI) (3.2 ± 1.5 vs. 2.6 ± 1.6, p=0.001) but had a lower GCS (6.4 ± 5.1 vs. 9.8 ± 4.7, p＜0.001), shorter ICU stay (4.9 ± 8.2 vs. 16.1 ± 12.3, p＜0.001), shorter hospital stay (9.6 ± 19.3 vs. 40.7 ± 35.4, p＜0.001), and lesser expenses (149358 ± 274827 vs. 425781 ± 384156, p＜0.001). Non-survivors with early mortality (＜24 hours) had a significantly higher APACHE II score (34.9 ± 8.9 vs. 30.3 ± 8.4, p＜0.001) and 93.5% (N=116) were medical patients. 18.9% (N=57) and 15% (N=45) survivors were discharged with cerebral performance category (CPC) 1 or 2 and ＞2 respectively. The survival rate was 33.9% (N=102), with 18.9% (N=57) of the survivors discharged with CPCS 1 or 2. The survivors with CPC ＞2 at discharge were older; had significantly higher APACHE II score and CCI; more medical expenses; longer ICU and hospital stays; related to the location of arrest but had a lower GCS. Multivariate analysis, the age (odds ratio, 2.32; 95%CI, 1.58-6.21; p=0.047); APACHE II (odds ratio, 1.46; 95%CI, 1.04-2.08; p=0.06) and GCS (odds ratio, 0.72; 95%CI, 0.39-1.46; p=0.039) on IHCA with survival to discharge were the risk factors associated with poor neurological outcome. Conclusions: Less than one fifth of the successfully resuscitated IHCA patients had a favorable neurological functional outcome at discharge. The mortality and outcomes were correlated to the severity of the disease.

並列關鍵字

in-hospital cardiac arrest (IHCA) ； outcomes