心脏骤停后自主循环恢复患者神经功能预后的性别差异及影响因素分析

Sex Differences in Neurological Outcomes and Associated Factors among Patients with Return of Spontaneous Circulation after Cardiac Arrest

摘要: 目的：探讨心脏骤停后自主循环恢复(ROSC)患者临床特征及神经功能预后的性别差异，并分析性别是否为预后的独立影响因素。方法：回顾性收集2021年1月至2025年1月于保定市第一中心医院收治的169例心脏骤停后ROSC患者的临床资料，按性别分为男性组(n = 112)和女性组(n = 57)。比较两组患者的基线特征、骤停相关因素、救治措施及出院时神经功能预后(CPC评分)。采用多因素Logistic回归分析性别对神经功能良好预后(CPC 1~2级)的独立影响。结果：169例患者中男性112例(66.3%)，女性57例(33.7%)。两组中位年龄相近(62.5 vs 65.0岁，P = 0.105)。与女性组相比，男性组心源性骤停比例更高(53.6% vs 35.1%, P = 0.023)，首次监测心律为可电击节律比例更高(40.2% vs 24.6%, P = 0.044)，电除颤实施率更高(47.3% vs 28.1%, P = 0.016)。男性组出院时神经功能良好率高于女性组(38.4% vs 22.8%, P = 0.042)。经多因素Logistic回归校正吸烟史、饮酒史、心脏骤停病因及首次监测心律后，性别并非神经功能良好预后的独立预测因素(OR = 1.104, 95% CI: 0.411~2.966, P = 0.844)。首次监测心律为可电击心律是出院时神经功能良好预后的独立预测因素(OR = 5.181, 95% CI: 2.220~12.090, P < 0.001)。结论：男性心脏骤停后ROSC患者神经功能良好率高于女性，但校正心脏骤停病因及首次监测心律后性别并非预后的独立影响因素，提示两性间的预后差距可能源于可电击心律分布的不同而非性别本身。

Abstract: Objective: To investigate sex differences in clinical characteristics and neurological outcomes among patients with return of spontaneous circulation (ROSC) after cardiac arrest, and to determine whether sex is an independent predictor of neurological prognosis. Methods: Clinical data of 169 post-cardiac arrest patients who achieved ROSC and were admitted to Baoding First Central Hospital from January 2021 to January 2025 were retrospectively collected. Patients were divided into a male group (n = 112) and a female group (n = 57). Baseline characteristics, cardiac arrest-related factors, treatment interventions, and neurological outcomes at discharge (Cerebral Performance Category [CPC] score) were compared between the two groups. Multivariable logistic regression was performed to assess the independent effect of sex on favorable neurological outcome (CPC 1~2). Results: Of 169 patients, 112 (66.3%) were male and 57 (33.7%) were female. The median ages were similar between groups (62.5 vs 65.0 years, P = 0.105). Compared with females, males had a higher proportion of cardiac etiology (53.6% vs 35.1%, P = 0.023), initial shockable rhythm (40.2% vs 24.6%, P = 0.044), and defibrillation (47.3% vs 28.1%, P = 0.016). The rate of favorable neurological outcome at discharge was higher in males than in females (38.4% vs 22.8%, P = 0.042). After multivariable logistic regression adjusting for smoking history, alcohol history, cardiac arrest etiology, and initial rhythm, sex was not an independent predictor of favorable neurological outcome (OR = 1.104, 95% CI: 0.411~2.966, P = 0.844). Initial shockable rhythm was the only independent predictor of favorable neurological outcome at discharge (OR = 5.181, 95% CI: 2.220~12.090, P < 0.001). Conclusion: Male post-cardiac arrest ROSC patients had a higher rate of favorable neurological outcome than females; however, after adjusting for cardiac arrest etiology and initial rhythm, sex was not an independent prognostic factor. The observed sex disparity in outcomes may be attributable to differences in the distribution of shockable rhythms rather than sex itself.