68例就诊过程中意外死亡病因分析

The Clinical Study of 68 Cases of Sudden Death During Treatment in Emergency Department

目的:探讨急诊医疗过程中意外死亡的原因,以引起广大同道的重视。方法:对急诊就诊过程中24 h内死亡且符合入选标准的68例患者进行死亡原因分析,分析意外死亡常见的病因并探讨死亡原因与就诊之初临床特征的关系。结果:68例意外死亡患者占同期死亡人数的4.39%,其中主动脉夹层31例,占同期死亡2%,占意外死亡的45.6%;心脏性猝死(急性心肌梗塞9例,心肌炎4例)13例占同期死亡病人的0.84%,占意外死亡总数的19.1%;急性脑血管病(小脑出血5例,小脑梗塞8例)13例,占同期死亡人数的0.84%,占意外死亡总数的19.1%;重症哮喘3例;不明原因死亡5例。临床特征多为胸痛、胸背痛、头痛、上腹痛、眩晕等为首发症状。结论:急诊就诊过程意外死亡发生取决于多种因素,由于这些病例症状多不典型,病情复杂多样,临床医师极易忽视,临床极易漏诊、误诊,一旦发生,都将引起较大的医疗纠纷,耗费大量的人力物力。因此对急诊就诊过程中的不典型特征高度重视及时考虑主动脉夹层、心脏性猝死、急性脑血管病,早期治疗,避免意外死亡的发生。

Objective：To explore the character of accidental death during treatment in emergency department,and get more attention of other emergent doctors to avoid death in aciergent treatment.Methods：To analysis death causes of 68 qualified patients,who died within 24 hours after they went to hospital;To analysis familiar accidental death causes and the relationship between them and initial clinical signs.Results：These 68 accidental dead patients occupied 4.39%in all dead patients during the same period,including 31 cases of aortic dissecting hematoma（2%in all dead patients vs 45.6%in accidental dead patients）;13 cases of sudden cardiac death（0.84%in all dead patients vs 19.1%in accidental dead patients）,which included 9 cases of acute myocardial infaction,4 cases of myocarditis;13 cases of acute cerebravascular diseases（0.84%in all dead patients vs 19.1%in accidental dead patients）,which included 5 cases of cerebella hemorrhage and 8 cases of cerebella infarction;3 severe asthma and other 5 cases without exact reasons. Clinical initial showed frequently the pain of breast,breast and back,head and upper belly,and dizzling.Conclusion： The happening of accidental death during treatment in emergent department was decided by many complicated factors. Because being non-typical and complicated,these factors always were ignored by clinical doctors,resulting wrong diagnosis or leaked diagnosis,which brought many clinical dissensions.Clinical dissensions cost much money and energy. So to know and pay more attention to these non-typical signs is very important to diagnosis aortic dissecting hematoma, sudden cardiac death and acute cerebravascular diseases,and is helpful to treat in time,and consequently the death was avoided.