中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2013年
2期
99-101
,共3页
石宗华%高传玉%刘林刚%张娆娆%徐瑞华
石宗華%高傳玉%劉林剛%張嬈嬈%徐瑞華
석종화%고전옥%류림강%장요요%서서화
重症监护病房%心室纤颤%除颤%心肺复苏%纽约心脏病协会心功能分级
重癥鑑護病房%心室纖顫%除顫%心肺複囌%紐約心髒病協會心功能分級
중증감호병방%심실섬전%제전%심폐복소%뉴약심장병협회심공능분급
Intensive care unit%Ventricular fibrillation%Defibrillation%Cardiopulmonary resuscitation%New York Heart Association classification
目的 了解重症监护病房患者除颤(DF)与心肺复苏(CPR)先后顺序以及心室纤颤(VF)时间和纽约心脏病协会(NYHA)心功能分级对DF效果的影响.方法 将需要紧急DF的93例患者按VF发生时间分为＜4 min组(53例)、4～8 min组(24例)、＞8 min组(16例)3组,每组再按先DF还是在5次循环的基本CPR后DF分为两个亚组.观察不同VF时间、DF和CPR先后顺序、不同NYHA心功能分级对DF成功率的影响.结果 随VF时间的延长,DF成功率明显下降[VF＜4 min、4～8 min、＞8 min组DF成功率分别为83.0％(44/53)、62.5％(15/24)、25.0％(4/16),两两比较均P＜0.01].VF＜4 min组,先DF者的DF成功率明显高于先CPR者[88.9％ (24/27)比76.9％ (20/26),P＜0.05]；VF 4 ～8 min组,先DF者的DF成功率略高于先CPR者[66.7％(8/12)比58.3％(7/12),P=0.09]；VF＞8 min组,先CPR者的DF成功率明显高于先DF者[37.5％(3/8)比12.5％(1/8),P＜0.01].随NYHA心功能分级增加,患者DF成功率逐渐下降[NYHA Ⅰ～Ⅳ级分别为96.4％(27/28)、80.0％(20/25)、47.8％ (11/23)、29.4％ (5/17),P＜0.05或P＜0.01].结论 心搏骤停VF持续时间及NYHA心功能分级是影响DF效果的重要因素；DF与CPR的先后顺序应结合心搏骤停VF持续时间区别对待；NYHA心功能分级较差者应提前做出某些预判及预防措施.
目的 瞭解重癥鑑護病房患者除顫(DF)與心肺複囌(CPR)先後順序以及心室纖顫(VF)時間和紐約心髒病協會(NYHA)心功能分級對DF效果的影響.方法 將需要緊急DF的93例患者按VF髮生時間分為＜4 min組(53例)、4～8 min組(24例)、＞8 min組(16例)3組,每組再按先DF還是在5次循環的基本CPR後DF分為兩箇亞組.觀察不同VF時間、DF和CPR先後順序、不同NYHA心功能分級對DF成功率的影響.結果 隨VF時間的延長,DF成功率明顯下降[VF＜4 min、4～8 min、＞8 min組DF成功率分彆為83.0％(44/53)、62.5％(15/24)、25.0％(4/16),兩兩比較均P＜0.01].VF＜4 min組,先DF者的DF成功率明顯高于先CPR者[88.9％ (24/27)比76.9％ (20/26),P＜0.05]；VF 4 ～8 min組,先DF者的DF成功率略高于先CPR者[66.7％(8/12)比58.3％(7/12),P=0.09]；VF＞8 min組,先CPR者的DF成功率明顯高于先DF者[37.5％(3/8)比12.5％(1/8),P＜0.01].隨NYHA心功能分級增加,患者DF成功率逐漸下降[NYHA Ⅰ～Ⅳ級分彆為96.4％(27/28)、80.0％(20/25)、47.8％ (11/23)、29.4％ (5/17),P＜0.05或P＜0.01].結論 心搏驟停VF持續時間及NYHA心功能分級是影響DF效果的重要因素；DF與CPR的先後順序應結閤心搏驟停VF持續時間區彆對待；NYHA心功能分級較差者應提前做齣某些預判及預防措施.
목적 료해중증감호병방환자제전(DF)여심폐복소(CPR)선후순서이급심실섬전(VF)시간화뉴약심장병협회(NYHA)심공능분급대DF효과적영향.방법 장수요긴급DF적93례환자안VF발생시간분위＜4 min조(53례)、4～8 min조(24례)、＞8 min조(16례)3조,매조재안선DF환시재5차순배적기본CPR후DF분위량개아조.관찰불동VF시간、DF화CPR선후순서、불동NYHA심공능분급대DF성공솔적영향.결과 수VF시간적연장,DF성공솔명현하강[VF＜4 min、4～8 min、＞8 min조DF성공솔분별위83.0％(44/53)、62.5％(15/24)、25.0％(4/16),량량비교균P＜0.01].VF＜4 min조,선DF자적DF성공솔명현고우선CPR자[88.9％ (24/27)비76.9％ (20/26),P＜0.05]；VF 4 ～8 min조,선DF자적DF성공솔략고우선CPR자[66.7％(8/12)비58.3％(7/12),P=0.09]；VF＞8 min조,선CPR자적DF성공솔명현고우선DF자[37.5％(3/8)비12.5％(1/8),P＜0.01].수NYHA심공능분급증가,환자DF성공솔축점하강[NYHA Ⅰ～Ⅳ급분별위96.4％(27/28)、80.0％(20/25)、47.8％ (11/23)、29.4％ (5/17),P＜0.05혹P＜0.01].결론 심박취정VF지속시간급NYHA심공능분급시영향DF효과적중요인소；DF여CPR적선후순서응결합심박취정VF지속시간구별대대；NYHA심공능분급교차자응제전주출모사예판급예방조시.
Objective To investigate whether the sequence of defibrillation (DF) and cardiopuhnonary resuscitation (CPR),duration of ventricular fibrillation (VF),and New York Heart Association (NYHA) classification would affect DF result in intensive care unit.Methods Ninety-three cases needing instantaneous DF were divided into three groups according to VF lasting time:＜4 minute group (n=53),4-8 minute group (n=24),＞8 minute group (n=16),and each group was randomly divided into two sub-groups according to time sequence:the prior DF group or the prior CPR for five cycles followed by DF group (prior CPR group).The effect of VF time,the sequence of DF and CPR,and NYHA classification on success rate of DF were observed.Results With prolonging VF time,success rate of DF obviously lowered [success rate of DF for VF ＜4 minute,4-8 minute,and ＞8 minute groups were 83.0％ (44/53),62.5％ (15/24),and 25.0％ (4/16),respectively,all P＜0.01].When VF time lasted less than 4 minutes,success rate of DF in the prior DF group was obviously higher than that in the prior CPR group [88.9％ (24/27) vs.76.9％ (20/26),P＜0.05].When VF time lasted for 4-8 minutes,the prior DF group had slightly higher success rate of DF compared with the prior CPR group [66.7％ (8/12) vs.58.3％ (7/12),P=0.09].When VF time lasted longer than 8 minutes,the success rate of DF in the prior CPR group was obviously higher than that in the prior DF group [37.5％ (3/8) vs.12.5％ (1/8),P＜0.01].The success rate of DF was lowered in higher NYHA classification [success rate of DF for NYHA classification Ⅰ-Ⅳ was 96.4％ (27/28),80.0％ (20/25),47.8％ (11/23),29.4％ (5/17),respectively,P＜0.05 or P＜0.01].Conclusions VF lasting time and NYHA classification are key factors to success rate of DF,and the choice of sequence of DF and CPR depends on the lasting time of VF.For cases with the high NYHA classification,we should make some judgement beforehand and prepare some preventive measures.
