深圳市2002年～2004年67家急救网络医院急诊科死亡患者救治分析  

Investigation of the patients who died in the departments of emergency in 67 emergency network hospitals in Shenzhen 2002-2004

作　　者：梁实 江捍平 许四虎 贾清旺[3] 周强[3] 赵小斐[3] 张淑霞[3] 张豪[4] 

机构地区：[1]深圳市滨海医院,广东518053 [2]深圳市卫生局 [3]深圳市急救中心 [4]深圳市宝安区观澜医院

出　　处：《中国急救复苏与灾害医学杂志》2009年第10期757-760,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：深圳市科技局立项课题（200404163,200702150）;深圳市卫生局指令项目,深卫医发[2005]24号;志谢：谢若斯、周复、韩春艳、张福林、郑静、石平、朱虹、赵伟、简洁、谢建琴、周泽强、杨径、严吉祥、谢旭、孙安琼、张文武、高翔、王苏、王合金、周承敦、郭有生、刘秀云、王伟娜、王宁、黄捷、陈小凡、何小平、周小华、曾仲意、孙伟、陈劲松、魏衍召等领导和专家参加了调查工作.各区卫生局和各急救网络医院对调查给予了大力支持和帮助.在此一并致谢!

摘　　要：目的查找急救各环节存在的问题，降低急救病死率和伤残率，为进一步完善全市急救网络提供客观依据。方法对2002—2004年度全市67家急救网络医院有在急诊科死亡的870例、1260例和704例患者的急救记录用问卷方式进行调查，用Profox 6．0建立数据库，用SPSS13．0统计分析。结果3年急诊科病死率分别为2．6238／万、2．5740／万和2．4418／万。到达急诊科后死亡患者以0：00—8：00am最多；3个年度首诊医师到场时间中位数均为0min；二线或上级医师到场中位数时间分别为1、0、0．5min；会诊医师到场中位数时间分别为20、5、5min。2004年度与2003年度相比，急救处置率、质量控制、落实制度等方面均有提高。3个年度间患者到达急诊科30min内病死率为32．81％，60min内病死率为59．76％，3h病死率为82．43％。结论深圳市急救网络医院急诊科首诊医师的急救意识较强，部分二线医师还有麻痹思想。急救操作率高，但急救管理仍需改善。Objective To investigate the objective status and problems existing in different links of emergency treatment so as to improve the city＇s emergency network. Methods Questionnaire survey was conducted on the medical records of 870,1260, and 704 cases who died in the emergency rooms （ERs） of 67 emergency network hospitals in Shenzhen, Guangdong Province, 2002 - 2004. Results The whole city＇s mortalities in emergency departments were 2.6238, 2.5740, and 2.4418 per ten thousands in the 3 years respectively. The time scale with the greatest number of emergency death cases after arriving at the ER was 0：00-8：00 am. The medians of first visiting doctor arriving time were all 0 minute after the patient arrived at the ERs in these 3 years. The medians of senior or second line doctor arriving time of 2002, 2003, and 2004 were 1, 0, and 0.5 rain respectively. The medians of the consultant doctor arriving time were 20, 5, and 5 min respectively in these 3 years. The rates of emergency treatment, such as cerebral resuscitation, oxygen supply, medical monitoring, and medication therapy, proportion of implementation of first visiting doctor responsibility system, detailed and standardized recording of rescue materials, and carrying out of death discussion in 2004 were all singnifieantly higher than those in 2003 （all P〈0.001） . Totally, 32.81% of the patients died within 30 minutes, 59.76% died within 60 minutes, and 82.43% died within 3 hours after they arrived at the ERs. Conclusion The rescue sense of the doctor in attendance is rather strong. Some of the second line doctors still show a decline of alertness. The rate of implementation of first aid operations is high. However, the management of emergency treatment still needs to be improved in the Shenzhen emergency network hospitals.

关 键 词：急诊科 急救网络医院 病死率 

分 类 号：R459.7[医药卫生—急诊医学]