外傷性到院前心跳停止患者，經急救後成功恢復自發性心跳之預測因子分析

Predictors of sustained return of spontaneous circulation in patients who suffer traumatic out-of-hospital cardiac arrest in Taiwan

李肇瑞(Chao-Jui Li)

指導教授 ： 李建宏

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2011年)

摘要

摘要
目的：患者發生外傷性到院前心跳停止，其預後相當不好。我們分析患者急救經過，找出可預測患者能回復持續性自發循環之急救相關因子。
方法：我們回朔分析高雄長庚醫院以及彰化基督教醫院急診室106位大於18歲之患者，分析患者到院前所發生的各種狀況及到院後患者所接受的治療，將患者分為有恢復持續性自發循環與未恢復自發性循環兩個族群做比較。除此之外針對接受不同時間長短之心肺復甦術患者做存活分析，同時利用ROC曲線找出能否回復持續自發性循環的急救時間。
結果：頭頸部外傷是最常見的外傷位置(50.9%)，神經損傷是最常見外傷性到院前心跳停止的成因(49.1%)；影響患者是否可回復持續自發性循環最重要的因素為患者到院時的心律，心室顫動或無脈性心律相對於完全無心臟電氣活性者有較好的急救成功率(OR 18.5, 95% CI 3.4—101.1)；其次在急救前30分鐘內給予輸液大於1600ml，相對接輸液小於1600ml者有較好的急救成功率(OR 4.7, 95% CI 1.5—14.8)。接受不同時間心肺復甦之患者，其存活時間有顯著差異(p=0.002)。
結論：心室顫動或無脈性心律相對於完全無心臟電氣活性者有較好的急救成功率，在急救前30分鐘內給予輸液大於1600ml，相對接輸液小於1600ml者有較好的急救成功率。

關鍵字

心跳停止, 外傷

並列摘要

Abstract
Study objective: Traumatic out-of-hospital cardiac arrest (OHCA) is associated with poor outcomes. We evaluated the predictors of achieving return of spontaneous circulation (ROSC) in adults during the early resuscitation period.
Methods: This retrospective study comprised 106 patients > 18 years who had been admitted to the emergency department (ED) with traumatic OHCA at two medical centers in Taiwan. Demographics including pre-hospital information and in-hospital treatment events were evaluated. Variables were compared between patients who achieved sustained ROSC and those who did not to determine possible predictors of outcome. Time-related survival analysis was used to analyze the likelihood of survival in patients who received different durations of in-hospital cardiopulmonary resuscitation (CPR). Receiver operating characteristic analysis was used to determine the duration of in-hospital CPR associated with sustained ROSC.
Results:
The head and neck (50.9%) were the most common sites of injury, and neurological injury (49.1%) was the most common cause of cardiac arrest. The two most important variables associated with achieving sustained ROSC were initial cardiac rhythm presenting as VF or PEA (OR 18.5, 95% CI 3.4—101.1) and administration of fluid totaling > 1600ml during the first 30 min of in-hospital care (OR 4.7, 95% CI 1.5—14.8). There was a significant difference in survival over time (p=0.002) among patients who received different durations of in-hospital CPR.
Conclusions:
Sustained ROSC was easily achieved in patients with initial cardiac rhythms presenting as VF or PEA and who received > 1600 ml of fluid during the first 30 min of in-hospital care.

並列關鍵字

cardiac arrest, traumatic OHCA, predictors, resuscitation, Taiwan

參考文獻

References

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