CAJ | 학술논문

目的探讨心肺复苏(CPR)中影响患者亲属提出不复苏(DNAR)意愿的患者自身相关因素.方法按Utstein模式要求登记温州医学院附属第一医院急诊科2005年1月至2008年12月院内心搏骤停(CA)患者522例,其中患者亲属提出DNAR意愿157例,为DNAR意愿组,其余365例为积极复苏意愿组.对患者年龄、性别、婚姻、户籍、CA病因、基础疾病、CA前活动状态、有无呼吸机辅助通气、有无使用升压药物等相关指标进行单因素Logistic回归分析,然后选择有统计学意义的变量进行多因素Logistic回归分析.结果单因素Logistic回归分析发现性别、婚姻对患者亲属提出DNAR意愿无统计学意义(P>0.05),年龄、户籍、CA病因(心源性、创伤性)、中风、癌症、猝死、CA前活动状态、有无呼吸机辅助通气、有无使用升压药10个指标对亲属提出DNAR意愿有统计学意义(P<0.01).多因素Logistic回归分析发现影响亲属提出DNAR意愿的独立危险因素有年龄(P=0.034)、癌症(P=0.006)、中风(P=0.003)、CA前呼吸机辅助通气(P=0.000),而猝死是保护因素(P<0.01).CA病因中,心源性(P=0.020)和创伤性(P=0.000)也是保护因素.结论在与患者亲属提出DNAR意愿相关的患者自身因素中,年龄≥60岁、癌症、中风、CA前呼吸机辅助通气是肯定的因素,猝死及CA病因中的心源性、创伤性是否定的因素.
목적 탐토심폐복소(CPR)중영향환자친속제출불복소(DNAR)의원적환자자신상관인소.방법안Utstein모식요구등기온주의학원부속제일의원급진과2005년1월지2008년12월원내심박취정(CA)환자522례,기중환자친속제출DNAR의원157례,위DNAR의원조,기여365례위적겁복소의원조.대환자년령、성별、혼인、호적、CA병인、기출질병、CA전활동상태、유무호흡궤보조통기、유무사용승압약물등상관지표진행단인소Logistic회귀분석,연후선택유통계학의의적변량진행다인소Logistic회귀분석.결과 단인소Logistic회귀분석발현성별、혼인대환자친속제출DNAR의원무통계학의의(P>0.05),년령、호적、CA병인(심원성、창상성)、중풍、암증、졸사、CA전활동상태、유무호흡궤보조통기、유무사용승압약10개지표대친속제출DNAR의원유통계학의의(P<0.01).다인소Logistic회귀분석발현영향친속제출DNAR의원적독립위험인소유년령(P=0.034)、암증(P=0.006)、중풍(P=0.003)、CA전호흡궤보조통기(P=0.000),이졸사시보호인소(P<0.01).CA병인중,심원성(P=0.020)화창상성(P=0.000)야시보호인소.결론재여환자친속제출DNAR의원상관적환자자신인소중,년령≥60세、암증、중풍、CA전호흡궤보조통기시긍정적인소,졸사급CA병인중적심원성、창상성시부정적인소.
Objective To study the factors influenceing patients' family members to make own relative fac-tors patients' families making decision on refusal of cardiopulmonary resuscitation (CPR) to the critical patients. Method Data were registered based on Utstein Style of 522 patients aged over 15 years, who subjected to in-hos-pital cardiac arrest(CA) in Department of Emergency of The First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2008. A total of 157 patients' family made refusal decision among the 522 pa-tients, who belonged to the refusal group, and others belonged to the attempt resuscitation group. The associated factors included age, sex, marriage, household register, cause of CA, underlying diseases, capability of activity before CA, life supported with mechanical ventilation, and administration of pressor agents. The refusal decisions were evaluated by using univariate Logistical regression analysis, and then the statistical significant variables were analyzed by using muhivanate Logistical regression analysis. Results Age, household register, cause of CA(car-diac or traumatic),stroke, sudden death, cancer, capability of activity before CA, life supported with mechanical ventilation,and administration of pressor agents were the important factors of making refusal decision (P < 0.01), but sexes or marriage was insignificant related to the refusal decision (P > 0. O5). The independent risk factors re-lated to refusal decision were age (P = 0.034),cancer (P = 0.006),stroke (P = 0.003), and life supported with mechanical ventilation (P = 0.000) in multivariate Logistical regression analysis, but the protective factors were sudden death (P =0.000),cardiac CA (P =0.020) and traumatic CA(P =0.000). Conclusions Age over 60 years, cancer, stroke, and life suppoted with assisted ventilation before CA were factors associated with re-fusal decision making, yet sudden death, cardiac CA and traumatic CA were factors of accepting CPR.