福州市2010年中心城区社区人群的院前急救分析及策略

Analysis and strategies of pre-hospital emergency care for a community-based population in urban areas of Fuzhou city in 2010

目的回顾性调查分析福州市中心城区所属社区人群院前急救的流行病学特点，探讨有效提高本地区院前急救能力及常见急诊疾病的防治策略。方法回顾性分析2010年福州市中心城区院前急救患者的疾病类型、年龄、性别、月份分布、呼叫反应时间及转归等。结果福州市中心城区2010年院前急救病例总计2130例。在2130例院前急救中，创伤类占院前急救比例最多，以31～40岁青壮年阶段为主；其次是心脑血管疾病，以50岁（尤其是70岁）以上的中老年患者明显居多，约占该年龄段的50．57％。男性院前急救的数量明显高于女性，男女比例为1．57：1。院前死亡190例，主要死因是创伤（69例，占36．32％），其次为心脑血管疾病，以50岁以上年龄段明显居多（53例，约占该年龄段81．54％）。院前猝死患者中，从发病至120现场抢救期间，目击者无一例行心肺复苏。院前急救与院前死亡患者均以冬春季节为最多。院前急救患者的呼叫反应时间、现场时间分别为（10．0．4-6．1）min、（11．8．4-5．9）min；院前死亡患者的呼叫反应时间、现场时间分别为（11．2±6．2）min、（29．0±21．1）min。结论（1）加强社区人群的卫生健康宣传力度，提高社区高危人群自身的防病意识，尤其针对心脑血管疾病的预防，可有效减少院前急症、甚至猝死的发生。（2）重视社区人群院前急救常识及心肺复苏技术的普及，对于提高院前急救水平、减少死亡有着重要意义。（3）加强急诊网络建设、严格遵循“就近原则”、院前120同相关部门紧密联合处理突发事件，可有效提高急诊医疗服务体系的效率。

Objective To retrospectively analyze the epidemiological characteristics of pre-hospital emergency care for a community-based population in the urban areas of Fuzhou city and to propose strategies for improving pre-hospital emergency care and the prevention and treatment of common emergency conditions. Methods Data of different sorts of diseases, age, gender, monthly variation in number of eases, time required to response the emergency call and outcome of care were retrospectively analyzed in patients who received pre-hospital emergency care in the urban areas of Fuzhou city in 2010. Results A total of 2130 subjects had pre-hospital emergency care in the urban areas of Fuzhou city. Among them, trauma was the major cause, and was found mainly in youths and adults aged 31 -40 years. Cardiovascular and cerebrovascular diseases were the second most common causes and were found mainly in patients aged 〉 50 years （especially in those 〉70） accounting for 50. 57% in patients of that age cohort. More males than females received pre-hospital emergency care （ h 57：1 ）. A total of 190 patients died during pre-hospital emergency care with trauma （n = 69, 36. 32% ）, the leading cause of death. Cardiovascular and cerebrovascular diseases were the second leading cause of death and found mainly in patients aged 〉 50（ n = 53） accounting for 81.54% of deaths in patients of this age cohort. Among patients with sudden death before admission, there was no one had cardiopulmonary resuscitation performed by witness before the emergency care given. Pre-hospital emergency care and pre-hospital deaths were more often occurred in the winter and spring seasons. The time required to response emergency call and the time elapsed to on-site emergency care were （ 10. 0 _ 6. 1 ） min and （ 11.8 ＋ 5.9） min, respectively, for patients receiving pre- hospital emergency care; and the time required to response the emergency call and the time elapsed to on- site emergency care were （ 11.2 ＋ 6.2） min and （29.0 -＋ 21.1 ） rain, respectively, for patients who died during the pre-hospital emergency care. Conclusions （1） It is imperative to provide heahhcare education to the community and to improve community awareness of the importance of the disease prevention, especially cardiovascular and cerebrovascular diseases, whereby this would effectively reduce the incidence of emergency care and sudden death. （2） It is also necessary to promote pre-hospital emergency care and cardiopulmonary resuscitation techniques, which are important for improving pre-hospital emergency care and reducing mortality. （ 3 ） Strengthening network integration and enforcing the ＂principle of proximity＂ are also important. Coordination between pre-hospita] emergency care workers and other relevant departments may improve the efficiency of the Emergency Medical Service System.