| 摘要: | 研究目標
對於中台灣院外心因性猝死患者，探討以心室頻脈、心室顫動作為最初表現的發生率以及院前預測因子。
研究病患與方法
大台中突發非預期死亡登錄資料主要在中台灣大台中都會區執行，面積為270萬平方公尺，共有十七家責任醫院收治院外猝死患者。本研究使用Utstein模式詳細分析人口特質統計資料、心因性猝死環境條件以及緊急救護系統紀錄。
結果
自2013年五月一日至2014年四月三十日，共有2013位院外猝死患者接受急救處置，其中有384位患者因非心因性猝死或是外傷性猝死而被排除。在1629位被認定為心因性院外猝死患者中，有百分之7.9(129位)的患者以可電擊心律表現；而這個比率在被目擊心臟停之次族群增加到百分之18.8(325位中的61位患者)。男性(勝算比為2.45；95％信賴區間為1.46¬-4.12；P<0.001)、年齡小於65歲(勝算比為2.39；95％信賴區間為1.58-3.62；P<0.001)、在公共地區猝死(勝算比為4.61；95%信賴區間為2.86-7.44；P<0.001)以及被目擊猝死(勝算比為3.98；95％信賴區間為2.62-6.05；P<0.001)為心室頻脈、心室顫動獨立預測因子。
結論
在東亞族群以心室頻脈、心室顫動表現的院外心因性猝死患者的比例一般來說相當低。在到院前心室頻脈、心室顫動預測因子中，對於這類族群，在公共地區猝死是最強的預測因子。這將影響中台灣地區緊急醫療服務之政策規劃與落實。
OBJECTIVE
To identify the incidence and prehospital predictors of ventricular tachycardia/ventricular fibrillation (VT/VF) as the initial arrhythmia in patients with out-of-hospital cardiac arrest (OHCA) in central Taiwan.
PATIENTS AND METHODS
The Taichung Sudden Unexpected Death Registry program encompasses the Taichung metropolitan area in central Taiwan, with a population of 2.7 million and 17 destination hospitals for patients with OHCA. We performed a detailed analysis of demographic characteristics, circumstances of cardiac arrest, and emergency medical service records using the Utstein Style.
RESULTS
From May 1, 2013, through April 30, 2014, resuscitation was attempted in 2013 individuals with OHCA, of which 384 were excluded due to trauma and noncardiac etiologies. Of the 1629 patients with presumed cardiogenic OHCA, 7.9% (n=129) had initial shockable rhythm; this proportion increased to 18.8% (61 of 325) in the witnessed arrest subgroup. Male sex (odds ratio [OR], 2.45; 95% CI, 1.46-4.12; P<.001), age younger than 65 years (OR, 2.39, 95% CI, 1.58-3.62; P<.001), public location of arrest (OR, 4.61; 95% CI, 2.86-7.44; P<.001), and witnessed status (OR, 3.98; 95% CI, 2.62-6.05; P<.001) were independent predictors of VT/VF rhythm.
CONCLUSION
The proportion of patients with OHCA presenting with VT/VF was generally low in this East Asian population. Of the prehospital factors associated with VT/VF, public location of OHCA was the strongest predictor of VT/VF in this population, which may affect planning and deployment of emergency medical services in central Taiwan. |
