急诊重症病例特点及死亡危险因素分析

Analysis of death risk factors and characteristics in emergency severe patients

目的分析急诊重症病例特点及死亡危险因素,为急诊工作的有效开展提供依据。方法采用回顾性分析方法,调查2011年1月～2012年12月重庆市巫山县人民医院急诊重症患者657例的基本及临床资料,根据预后分为生存组(n=491)和死亡组(n=166),比较不同预后患者的疾病谱及基础疾病情况,并采用单因素及多因素Logistic分析探讨与急诊重症患者死亡相关的因素。结果患者病死率为25.3%(166/657)。患者死亡构成比较高的疾病主要分布在神经系统(33.73%)、循环系统(31.32%)和消化系统(14.46%)。657例患者中伴随基础疾病者818例次,其中,伴随肝硬化、慢性心功能不全、脑血管疾病及慢性阻塞性肺疾病(COPD)的患者病死率分别为54.17%、38.19%、31.51%、28.68%。单因素分析显示,年龄、发病时间、平均动脉压、呼吸、循环、肝肾、凝血功能障碍、电解质紊乱及酸碱平衡失调、格拉斯哥昏迷(GCS)评分及急性生理功能和慢性健康状况(APACHE)Ⅱ评分均为急诊危重症患者死亡率的影响因素(P<0.05)。多因素Logistic分析显示,呼吸(OR=2.374)、循环(OR=2.533)、肝肾(OR=1.738)功能障碍及低GCS评分(OR=1.691)、高APACHEⅡ评分(OR=2.169)为急诊危重症患者死亡的危险因素,同时,40～60岁患者为死亡高发年龄(OR=0.503)。结论与急诊重症患者死亡相关的危险因素较多,在临床工作中,对出现的危重症死亡危险因素的患者应引起临床工作者的重视,即时给予对症抢救治疗,挽救患者生命,降低病死率。

Objective To analyze the death risk factors and characteristics in emergency severe patients, to provide basis for emergency work developing effectively. Methods Retrospective analysis method was used. Basic data and clinical data of 657 cases of emergency severe patients People＇s Hospital of Wushan County from January 2011 to December 2012 were investigated. All patients were divided into the survival group （n = 491） and the death group （n = 166） according to the prognosis; the spectrum of disease and basic diseases situation of patients with different prognosis were compared. The death risk factors of emergency severe patients were discussed by single-factor analysis and multi-factor Logistic analysis. Results The mortality was 25.3% （166/657） among all the patients. The diseases which had high constituent ratio of death were main distribution in nervous system （33.73%）, circulatory system （31.32%） and digestive system （14.46%）, which had accounted above 70% of total constituent ratio of death. 817 cases were combined with basic diseases among all 657 patients, death rates of combined cirrhosis, chronic cardiac insufficiency, cerebrovascular disease and COPD were 54.17%, 38.19%, 31.51%, 28.68% respectively. Age, disease time, mean arterial pressure, respiratory dysfunction, circulatory dysfunction, liver and kidney dysfunction, coagulation disorders, electrolyte and acid-base balance disorders, GCS score, APACHE Ⅱ score were the influencing factors of mortality in emergency severe patients according to single-factor analysis （P 〈 0.05）. Respiratory dysfunction （OR = 2.374）, circulatory dysfunction （OR = 2.533）, liver and kidney dysfunction （OR = 1.738）, low GCS score （OR = 1.691） and high APACHE Ⅱ score （OR = 2.169） were risk factors of mortality in emergency severe patients, at the same time, high incidence of death （OR = 0.503） was found in patients aged 40-60 according to multi-factor Logistic analysis. Conclusion There are many risk factors associated with death of emergency severe patients, so in the clinical work, clinical staffs should pay more attention to the patients with critical risk factors of death, give appropriate rescue treatment instantaneously, save patients＇ life, and reduce the mortality.