NEJM：院内心跳骤停患者的存活率或更高

2012年11月20日 --近日，刊登在国际杂志NEJM上的一篇研究报告指出，近十年来在医院经历心跳骤停的患者，其生存率明显提高了。这项研究由爱荷华大学的研究者进行，同时也揭示了患者生存率的提高也伴随着其神经系统疾病发生率的降低。

这项研究中，研究者对大约85，000名经历过心脏骤停的患者进行了研究(2000年至2009年住院的患者)，研究发现，这些患者的生存率从2000年的13.7%增长到了2009年的22.3%。

心跳骤停期间所发生的神经性损伤可以引发患者残疾或者生活质量严重降低，因此研究者想研究是否患者生存率的改善可以降低其神经性疾病发生的比例，研究结果显示，患者神经失能的比例从2000年的32.9%降低至了2009年的28.1%。

尽管在2000年时患者的生存率较低，但是研究揭示了10年间患者生存率的明显改善，这项研究对374个医院进行了综合研究，这项研究有助于帮助研究者改善病人的生活质量以及生存率。

尽管这项研究不能指出具体是那些因素的改变可以改善患者的生存率，可是研究揭示了在患者由于心脏骤停后的复苏疗法的改善，研究者指出，提高患者生存率的的因素对于其它医院心脏骤停患者的治疗具有一定的借鉴意义。相关研究由美国心脏协会提供支持。

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Trends in Survival after In-Hospital Cardiac Arrest

Background Despite advances in resuscitation care in recent years, it is not clear whether survival and neurologic function after in-hospital cardiac arrest have improved over time. Methods We identified all adults who had an in-hospital cardiac arrest at 374 hospitals in the Get with the Guidelines–Resuscitation registry between 2000 and 2009. Using multivariable regression, we examined temporal trends in risk-adjusted rates of survival to discharge. Additional analyses explored whether trends were due to improved survival during acute resuscitation or postresuscitation care and whether they occurred at the expense of greater neurologic disability in survivors. Results Among 84,625 hospitalized patients with cardiac arrest, 79.3% had an initial rhythm of asystole or pulseless electrical activity, and 20.7% had ventricular fibrillation or pulseless ventricular tachycardia. The proportion of cardiac arrests due to asystole or pulseless electrical activity increased over time (P<0.001 for trend). Risk-adjusted rates of survival to discharge increased from 13.7% in 2000 to 22.3% in 2009 (adjusted rate ratio per year, 1.04; 95% confidence interval [CI], 1.03 to 1.06; P<0.001 for trend). Survival improvement was similar in the two rhythm groups and was due to improvement in both acute resuscitation survival and postresuscitation survival. Rates of clinically significant neurologic disability among survivors decreased over time, with a risk-adjusted rate of 32.9% in 2000 and 28.1% in 2009 (adjusted rate ratio per year, 0.98; 95% CI, 0.97 to 1.00; P=0.02 for trend). Conclusions Both survival and neurologic outcomes after in-hospital cardiac arrest have improved during the past decade at hospitals participating in a large national quality-improvement registry. (Funded by the American Heart Association.)