66例到达前死亡患儿急诊抢救分析

The analysis on 66 children with dead on arrival in emergency department

目的探讨到达前死亡（deadOilarrival，DOA）患儿的原因及影响复苏的因素。方法收集我院急诊科2010年1月至2012年4月收治的66例DOA抢救不成功患儿的临床资料进行分析探讨。结果66例DOA患儿入院时均心跳呼吸停止，停止10rain14例，30min-1h12例，另有40例停止时间不详。家长自行抱送入院44例，占68．2％，外院转运22例，占31．8％。DOA患儿的原发疾病以重症肺炎合并呼吸衰竭和（或）心力衰竭、颅内感染、新生儿疾病等为主；所有患儿经预检分诊立即至抢救室复苏，均建立了静脉通道并注射了肾上腺素等复苏药物，48例进行了气管插管，但由于心跳呼吸停止时间长，66例患儿全部死亡。结论DOA是儿科高风险的重要原因之一，完善儿童急诊医疗体系、加强家长健康教育、开展大众复苏培训、建立健全医院急诊ICU的同质化服务是减少DOA发生和提高抢救成功率的关键。

Objective To investigate the causes and influencing factors of dead on arrival （DOA） in children. Methods The clinic data from 66 children with DOA admitted in the emergency department of Hunan Children＇s Hospital from Jan 2010 to Apr 2012 were analyzed retrospectively. Results All of the 66 cases had cardiac respiratory arrest when admission. Fourteen cases had arrest for 10 minutes, 12 cases for 30 minutes to an hour,40 cases had no details. Forty-four （68.2%） cases were carried by parents,22（31.8% ） cases were transferred by medical professionals. The main causes of DOA were severe pneumonia with respir- atory failure and （or） heart failure,intracranial infection, neonatal diseases. All cases were taken to resuscita- tion room by triage immediately. Tracheal intubations were completed in 48 cases and intravenous access with injection of epinephrine and other resuscitative drugs were established in all cases, but all cases were dead due to breathing and heartbeat stopped for a long time. Conclusion DOA is one of the important reasons for pediatric high-risk. The key of reduction of DOA incidence and improvement of survival rate is to improve pediatric emergency medical service system, strengthen the health education for the parents, to carry out training and establish homogenization service in emergency ICU.