院前突发死亡患者生命末期死亡质量回顾性分析

Retrospective analysis of the quality of death at the end of life in sudden prehospital deaths

目的探讨院前突发死亡患者抢救决策及其影响因素,为提升此类人群死亡质量及开展干预研究提供参考。方法选择2015年1月—2019年12月于徐州某综合性三甲医院急诊科就诊的456例院前突发死亡患者病例资料,回顾性分析其一般资料和抢救过程记录,将抢救时长划分为不同等级,并采用秩和检验和多元有序Logistic回归分析性别、年龄、死亡原因、院前意识丧失时长与抢救时长的关系。结果 456例院前突发死亡患者抢救时长平均为66.61min,中位数为55.00(0,485)min,441例(96.7%)进行基础生命支持,425例(93.2%)建立高级气道。单因素分析结果显示,不同性别、年龄和突发死亡原因的患者在抢救时长上的差异有统计学意义(均P<0.05)。有序多分类Logistic回归分析结果表明,男性、年龄在60周岁及以下、死因为非猝死者是抢救时长的影响因素(均P<0.05)。结论院前突发死亡患者抢救持续时间普遍较长,该类人群死亡质量偏低,希望在以后的抢救工作中能更加关注患者生命末期的生存质量,进行合理、有效的抢救复苏。

Objective To investigate the rescue strategies and influencing factors of sudden prehospital death in Department of Emergency in a first-class tertiary hospital of Xuzhou,so as provide reference for improving the quality of death and intervention research.Methods A total of 456 pre-hospital death cases in Department of Emergency of a first-class tertiary hospital from January 2015 to December 2019 were enrolled and their general information and rescue records were retrospectively analyzed.According to rescue duration,they were divided into different grades.Furthermore,the rank sum test and multiple ordered logistic regression were used to explore the correlation between sex,age,death reasons,pre-hospital unconscious time and rescue time.Results The average rescue time of 456 sudden pre-hospital death was 66.61 min,with a median of 55.00(0,485)min,where 441 patients(96.71%)received basic life support,and 425 patients(93.2%)established advanced airway.Univariate analysis indicated statistical differences in rescue time between different sex,ages and causes of sudden death(all P<0.05).Multiple logistic regression analysis revealed that men,aged 60 or below,and non-sudden death were the risk factors of rescue time(all P<0.05).Conclusions The rescue time for sudden pre-hospital death is generally longer and the quality of death in this group is low.It is necessary to pay more attention to the quality of life at the end of life,so as to perform reasonable and effective rescue work.