急诊内科昏迷的病因和临床急救对策分析

Etiology for Emergency Internal Medicine Coma and Clinical Emergency Countermeasures Analysis

目的探讨急诊内科昏迷的常见病因,提出针对昏迷病因进行的临床急救对策。方法回顾性分析了我院2003年6月至2008年6月收治的241例急诊内科昏迷患者的临床资料,对昏迷患者的病因进行分析研究,统计出不同病因昏迷患者所占的构成比及抢救成功率与病死率,了解年龄、性别、昏迷程度及病因等因素与患者昏迷预后的相关性。结果昏迷的病因所占构成比较大的是心脏停搏(17.01%)、脑出血(16.18%)、大面积脑梗死(13.69%)。241例患者最终抢救成功者190例,成功率为78.84%。抢救失败死亡的51例,病死率为21.16%,占前3位死亡的是心脏停搏30例、脑出血6例、脑梗死5例。性别、年龄及病因与昏迷死亡的无统计学意义,而昏迷程度与患者死亡呈正相关,中、重度昏迷的患者病死率为32.47%,显著高于轻度昏迷患者的病死率1.14%(P<0.05)。结论中重度昏迷病死率高,除了针对不同病因所致的昏迷进行病因治疗外,还应该保护脑细胞的功能,提高脑复苏的成功率,降低中重度昏迷患者的病死率。

Objective To explore the etiology of emergency internal medicine coma and the clinical emergency countermeasures. Methods A retrospective analysis of the clinical data of 241cases of emergency internal medicine coma patients admitted to the hospital from June 2003 to June 2008,analyzed the cause of coma patients, statistic the different causes of coma patients constitute ratio and success rate and mortality, explored the relationship of factors of age, gender, coma degree and cause of coma and patients prognosis. Results For the cause of coma, the top three is cardiac arrest （17.01%）, cerebral hemorrhage （16.18%）, massive cerebral infarction （13.69%）. On the241 patients 190 patients were ultimately rescued, the success rate is 78.84%. 51 cases died, the mortality rate was 21.16%, the top three death coma is cardiac arrest （30 cases）, cerebral hemorrhage（6 cases）, cerebral infarction （5 cases） . There are no statistically relationship between Gender, age and cause of death coma with patients mortality. The severe degree of coma has positively correlated with mortality, The mortality of moderate and severe coma are 32.47%,significantly higher than that of patients with hypo-coma which is 1.14%（P〈0.05）. Conclusion Moderate to severe coma have high mortality, in addition to the specific treatment for different causes coma, we should also protect brain cells function, to improve the success rate of cerebral resuscitation. Reduce the mortality in severe coma patients.