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目的分析老年人院外心搏骤停(OHCA)的流行病学特征,探讨影响老年人OHCA预后的相关因素。方法参照Utstein模式收集2012年1月~2016年10月浙江省人民医院急诊科、绍兴市急救中心和宁波市急救中心接诊的625例OHCA患者,根据年龄分为老年组326例和中青年组299例,回顾性分析患者临床资料。比较2组流行病学特征及预后差异,并进行回归分析。结果与中青年组比较,老年组患者发作地点在家里比例更高(79.1%vs47.5%),初始心律表现为不可电击心律(89.9%vs 84.6%)和发病原因为心源性(52.5%vs 44.5%)及被目击比例(77.6%vs 70.6%)更高(P<0.05,P<0.01)。老年组在现场/途中自主循环恢复(ROSC)、急诊室ROSC、存活住院及存活出院比例均明显低于中青年组(P<0.05,P<0.01)。初始心律为可电击心律、急救反应时间<10min、旁观者心肺复苏及院外除颤是老年OHCA患者出现ROSC的独立预测因素。结论老年OHCA在发作地点、初始心律、病因及被目击等上有特点;预后较中青年OHCA差;完善相关急救措施可能增加ROSC率。
Objective To analyze the epidemiological characteristics of OHCA in the elderly and to explore the related factors that affect the prognosis of OHCA in the elderly. Methods According to the Utstein model, 625 OHCA patients admitted to the Emergency Department of Zhejiang Provincial People’s Hospital, Shaoxing Emergency Center and Ningbo Emergency Center from January 2012 to October 2016 were divided into three groups according to their ages: 326 elderly patients and middle-aged youth patients 299 cases, retrospective analysis of clinical data. The epidemiological characteristics and prognosis of the two groups were compared and analyzed by regression analysis. Results Compared with the middle-aged and young group, the proportion of patients in the elderly group was higher at home (79.1% vs 47.5%), the initial rhythm was not shocked (89.9% vs 84.6%) and the cause was cardiogenic (52.5% vs 44.5%) and witnessed proportion (77.6% vs 70.6%) (P <0.05, P <0.01). ROSC, ROSC, surviving hospitalizations and surviving discharge in the elderly group were significantly lower than those in the middle-aged and young adults (P <0.05, P <0.01). The initial rhythm was shockable rhythm, emergency response time <10min, bystander cardiopulmonary resuscitation and hospital-based defibrillation were independent predictors of ROSC in elderly OHCA patients. Conclusion Elderly OHCA in the attack site, the initial rhythm, etiology and were witnessed, etc. have the characteristics; prognosis than young and middle-aged OHCA poor; improve the relevant emergency measures may increase ROSC rate.