作者：薛占英，孙旺东，李佳骏，王洪侠

单位：

北京怀柔医院120急救分中心

Units：

120FirstAidSub-center,BeijingHuairouHospital,Beijing101400,China

关键词：

猝死,心脏; 院前指导自救; 高级生命支持; 心肺复苏; 脑功能;

Keywords：

Death,sudden,cardiac;Pre-hospitalguidanceforself-rescue;Advancedlifesupport;Cardiopulmonaryresuscitation;Brainfunction

CLC：

R541

DOI：

10.12114/j.issn.1008-5971.2023.00.068

Funds：

摘要：

目的 探讨院前指导自救联合现场高级生命支持(ALS)在心源性猝死(SCD)患者急救中的应用效果。方法 选取2020年2月至2022年2月北京怀柔医院120急救分中心收治的经院前指导自救联合现场ALS抢救成功的SCD患者71例作为观察组，另按照年龄进行1∶1匹配，选取同期本院120急救分中心收治的经传统急救方案抢救成功的SCD患者71例作为对照组。比较两组基线资料、心肺复苏成功后血气指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血氧饱和度(SaO2)]、心肺复苏成功后心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、E/A比值、QT离散度(QTd)]、心肺复苏成功后脑氧代谢指标[颈内静脉血氧含量(CajvO2)、颈内静脉血氧饱和度(SjvO2)、脑氧摄取率(CEO2)]、心肺复苏成功后24 h格拉斯哥昏迷量表(GCS)评分、心肺复苏成功后2周日常生活活动能力(ADL)分级、院内死亡率及康复出院率。结果 观察组心肺复苏成功后PaO2、SaO2高于对照组，PaCO2低于对照组(P<0.05)。观察组心肺复苏成功后LVEF、E/A值高于对照组，LVEDD小于对照组，QTd短于对照组(P<0.05)。观察组心肺复苏成功后CajvO2、SjvO2、CEO2及心肺复苏成功后24 h GCS评分高于对照组(P<0.05)。观察组心肺复苏成功后2周ADL分级优于对照组，院内死亡率低于对照组，康复出院率高于对照组(P<0.05)。结论 院前指导自救联合现场ALS可有效改善SCD患者心肺复苏成功后血气指标、心功能，提高心肺复苏成功后脑氧代谢水平、日常生活活动能力，降低院内死亡率，有助于改善患者预后。

Abstract：

ObjectiveTo investigate the application effect of pre-hospital guidance for self-rescue combined with on-site advanced life support (ALS) in the emergency treatment of patients with sudden cardiac death (SCD) . Methods Seventy-one patients with SCD who were successfully treated with pre-hospital guidance for self-rescue combined with on- site ALS in 120 First Aid Sub-center of Beijing Huairou Hospital from February 2020 to February 2022 were selected as the observation group. In addition, 71 patients with SCD who were successfully treated with traditional first aid in 120 First Aid Sub-center of the same hospital during the same period were selected as the control group according to age 1 ∶ 1 matching. Baseline data, blood gas indexes [arterial partial pressure of oxygen (PaO2) , arterial partial pressure of carbon dioxide (PaCO2) , oxygen saturation of blood (SaO2) ] after successful cardiopulmonary resuscitation, cardiac function indexes [left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter (LVEDD) , E/A value, QT dispersion (QTd) ] after successful cardiopulmonary resuscitation, cerebral oxygen metabolism indexes [jugular venous arteriovenous oxygen content (CajvO2) , jugular venous oxygen saturation (SjvO2) , cerebral extraction of oxygen (CEO2) ] after successful cardiopulmonary resuscitation, Glasgow Coma Scale (GCS) score at 24 h after successful cardiopulmonary resuscitation, activity of daily living (ADL) grade at 2 weeks after successful cardiopulmonary resuscitation, in-hospital mortality and recovery and discharge rate were compared between the two groups. ResultsAfter successful cardiopulmonary resuscitation, PaO2and SaO2in the observation group were higher than those in the control group, while PaCO2was lower than that in the control group (P < 0.05) . After successful cardiopulmonary resuscitation, the LVEF and E/A value of the observation group were higher than those of the control group, while LVEDD was lower than that in the control group, and QTd was shorter than that in the control group (P < 0.05) . CajvO2, SjvO2, CEO2after successfulcardiopulmonaryresuscitationandGCSscoresat24haftersuccessfulcardiopulmonaryresuscitationintheobservationgroupwerehigherthanthoseinthecontrolgroup(P<0.05).TheADLgradeat2weeksaftersuccessfulcardiopulmonaryresuscitationoftheobservationgroupwasbetterthanthatofthecontrolgroup,thein-hospitalmortalitywaslowerthanthatofthecontrolgroup,andtherecoveryanddischargeratewashigherthanthatofthecontrolgroup(P<0.05).ConclusionPre-hospitalguidanceforself-rescuecombinedwithon-siteALScaneffectivelyimprovebloodgasindexes,cardiacfunction,cerebraloxygenmetabolismanddailylivingabilityofpatientswithSCDaftersuccessfulcardiopulmonaryresuscitation,reducein-hospitalmortality,andishelpfultoimprovetheprognosisofpatients.

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