首诊诊断未明行症状查因诊断的急诊患者临床分析

Clinical Analysis of Emergency Patients Diagnosed by Symptoms Related Enquires

目的了解急诊患者中因首诊诊断未明确而采用症状查因诊断患者的症状类型及其住院率和病死率,探讨采用症状查因诊断对患者治疗和预后的影响。方法对17726例首诊诊断未明确而采用症状查因诊断的急诊患者的资料进行回顾性分析。结果(1)17726例采用症状查因诊断的患者占同期急诊患者的5·3%,占同期急诊留观和急诊抢救患者的17·5%。居前3位的症状分别是腹痛、发热和头痛。(2)17726例患者经急诊治疗痊愈出院16960例,需进一步住院治疗者693例,住院率为3·9%。需要住院患者中临床症状居前3位的分别是昏迷(26·7%)、抽搐(18·2%)、气促(16·0%)。经急诊抢救无效死亡73例,急诊病死率为0·4%,病死率居前3位的症状分别为昏迷(18·2%)、抽搐(0·92%)、胸痛(0·90%)。结论(1)在采用症状查因诊断的急诊患者中,腹痛查因、发热查因、头痛查因最常见。(2)采用症状查因诊断的患者出院率高于诊断明确者,但住院率和病死率与诊断明确者无差别。

Objective To find out common types of symptoms experienced by emergency patients who had no certain diagnosis after medical examinations and later diagnosed by symptoms related enquires; to observe the hospitalization and mortality rate of these patients; to investigate the impact of symptoms related enquires on the treatment and prognosis of these patients. Methods The data of 17 726 emergency patients who diagnosed by symptoms related enquires were analyzed retrospectively. Results （ 1 ） 17 726 cases accepting symptoms related enquires made up 5.3% of the total emergency patients during the same period, and 17.5% of the patients who were in need for clinical observation and acute medical intervention. The 3 most common symptoms presented were abdominal pain, fever and headache. （2） Among 17 726 patients, 16 960 cases were fully recovered and 693 （3.9%） cases needed hospitalization. The 3 main contributing factors for impatient management were coma （26.7%）, clonus （ 18. 2% ） cand dyspnea （ 16% ）. 73 patients （0.4%） were dead after failed resuscitation in emergency room. The three leading death causes were coma （ 18.2% ） , clonus （0.92%） and chest pain （0.90%）. Conclusion （ 1 ） The most common symptoms seen among the patients who have uncertain diagnosis are abdominal pain for investigation, fever for investigation and headache for investigation. （2） The discharge rate of patients with symptoms based diagnosis was significantly higher than that of patients with clear pathogeny diagnosis （ P 〈 0. 05 ）, while no significant difference was found in hospitalizationrate and mortality rate between these two groups.