基于急诊临终患者病例分析探讨急诊舒缓护理需求

Based on the analysis of emergency dying patients to explore the demand of emergency palliative care

目的通过分析急诊死亡和心肺复苏患者病历资料,探讨急诊临终患者舒缓护理需求与模式。方法回顾性分析苏州大学附属第二医院2017—2020年收治776例急诊临床死亡和心肺复苏患者临床资料。结果最终纳入687例数据,年龄(70.38±16.57)岁;≥75岁患者占49.8%(342/687);其中36.0%(247/687)患者及家属在患者生命最后阶段选择不给予心肺复苏(DNR)。急诊临终DNR患者年龄≥75岁占63.2%(156/247),DNR患者按疾病进行分类统计,排名前4位的为脑出血、呼吸衰竭、多器官功能障碍综合征、院前心跳呼吸骤停。心肺复苏成功患者中有37.5%(45/120)的患者家属再次选择放弃治疗。选择DNR的患者在急诊抢救室停留中位时间为738.7 min。结论急诊临终患者及家属选择DNR的对象主要为年龄≥75岁、疾病类型为脑出血、呼吸衰竭、多器官功能障碍综合征、院前心跳呼吸骤停的危重患者,这类患者滞留急诊增加了抢救室的拥堵,同时不能得到安宁的舒缓护理环境,建议急诊医护人员加强舒缓护理意识,提高舒缓护理能力,给予急诊临终DNR患者相对独立的区域和与之相适应的舒缓治疗和护理。

Objective To explore the demand and mode of palliative care for emergency dying patients by analyzing the case data of emergency death and cardiopulmonary resuscitation.Methods The data of 776 cases of emergency clinical death and cardiopulmonary resuscitation in the Second Affiliated Hospital of Soochow University from 2017 to 2020 were retrospectively analyzed.Results A total of 687 patients were included with(70.38±16.57)years old,and 49.8%(342/687)of them were 75 years old and above;among them,36.0%(247/687)patients or their families chose not to give cardiopulmonary resuscitation(DNR)in the last stage of their lives,and 63.2%(156/247)of DNR patients were 75 years old and above.The top four etiology of DNR were cerebral hemorrhage,respiratory failure,multiple organ dysfunction syndrome and out of hospital cardiac and respiratory arrest.After successful cardiopulmonary resuscitation,37.5%(45/120)of the patients'family members chose to give up treatment again.The median stay time of DNR patients in the emergency room was 738.7 minutes.Conclusions The patients who choosed DNR were mainly 75 years old and above,with cerebral hemorrhage,respiratory failure,multiple organ failure and cardiac and respiratory arrest.The detention of these patients in the emergency room increases the congestion of the emergency room,and at the same time,they can not get a peaceful palliative care environment.It is suggested that emergency medical staff should strengthen the awareness and improve the ability of palliative care.A relative independent area and corresponding soothing palliative treatment and nursing should be given to the DNR patients.