摘要
目的探讨院外心脏骤停(out-of-hospital cardiac arrest,OHCA)患者出院存活的危险因素并构建列线图预测模型。方法回顾性分析2018年1月至2022年2月沧州市中心医院ICU收治的108例OHCA并心肺复苏(CPR)成功患者的临床资料。采用Logistic回归分析筛选OHCA患者出院存活的危险因素,采用一致性指数(C-指数)、校准曲线和决策曲线,分析评估列线图预测模型对OHCA患者出院存活的预测价值。结果108例OHCA患者出院存活37.96%(41/108)。出院存活和院内死亡两组OHCA患者旁观者CPR(χ^(2)=8.70,P=0.003)、可除颤心律(χ^(2)=9.64,P=0.002)、无复流时间(χ^(2)=38.10,P<0.001)、CPR持续时间(χ^(2)=5.02,P=0.025)、肾上腺素用量(χ^(2)=7.13,P=0.008)及血乳酸(Z=3.01,P=0.003)差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,旁观者CPR(OR=0.20,95%CI 0.05~0.75,P=0.017)、可除颤心律(OR=7.46,95%CI 1.75~31.77,P=0.007)、无复流时间(OR=0.79,95%CI 0.68~0.92,P=0.002)及肾上腺素用量(OR=0.61,95%CI 0.41~0.93,P=0.022)为OHCA患者出院存活的独立危险因素。列线图预测模型的C-指数为0.88(95%CI 0.82~0.95)。Hosmer-Lemeshow检验表明,列线图预测模型具有良好的拟合度(χ^(2)=5.49,P=0.705)。决策曲线分析证实,列线图预测模型的临床可用性良好。结论旁观者CPR、可除颤心律、无复流时间及肾上腺素用量为OHCA患者出院存活的危险因素,列线图模型可预测OHCA患者出院存活。
Objective To explore the risk factors of survival to hospital discharge after out-of-hospital cardiac arrest(OHCA)and to establish nomogram prediction models.Methods The clinical data of 108 OHCA patients with successful cardiopulmonary resuscitation(CPR)admitted to ICU of Cangzhou Central Hospital from January 2018 to February 2022 were retrospectively analysed.The Logistic regression was used to analyze the risk factors for survival to hospital discharge,and concordance index(C-index),calibration plot,and decision curve analysis were used to evaluate the value of nomogram prediction model in predicting survival to hospital discharge for OHCA patients.Results 37.96%(41/108)of OHCA patients survived to hospital discharge.The bystander CPR(χ^(2)=8.70,P=0.003),shockable rhythm(χ^(2)=9.64,P=0.002),no-flow time(χ^(2)=38.10,P<0.001),CPR duration(χ^(2)=5.02,P=0.025),epinephrine dosage(χ^(2)=7.13,P=0.008),and arterial lactate(Z=3.01,P=0.003)were statistically different between survival to hospital discharge and hospital death groups(P<0.05).Multivariate Logistic regression analysis showed that bystander CPR(OR=0.20,95%CI 0.05-0.75,P=0.017),shockable rhythm(OR=7.46,95%CI 1.75-31.77,P=0.007),no-flow time(OR=0.79,95%CI 0.68-0.92,P=0.002),and epinephrine dosage(OR=0.61,95%CI 0.41-0.93,P=0.022)were independent risk factors for survival to hospital discharge in OHCA patients.The C-index of the nomogram prediction model was 0.88(95%CI 0.82-0.95).The Hosmer-Lemeshow test showed that the nomogram prediction model had a good fit(χ^(2)=5.49,P=0.705).Decision curve analysis confirmed the good clinical usability of the nomogram prediction model.Conclusions The bystander CPR,shockable rhythm,no-flow time,and epinephrine dosage are independent risk factors for survival to hospital discharge,and nomogram prediction model can predict survival to hospital discharge in OHCA patients.
作者
杨风梅
冯顺易
王文杰
李勇
Yang Feng-mei;Feng Shun-yi;Wang Wen-jie;Li Yong(Department of Emergency Medicine,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《中国急救医学》
CAS
CSCD
2022年第12期1034-1038,共5页
Chinese Journal of Critical Care Medicine
基金
沧州市科学计划项目(204106127)。
作者简介
杨风梅(1975-),女,主管护师,E-mail:yangfm_2021@sina.com;通信作者:王文杰(1976-),女,硕士,副主任医师,E-mail:wwj1393176@hotmail.com。
