不同重症监护室死亡患者的临床特点分析  

Analysis of the clinical features of lethal cases in different intensive care units

作　　者：胡春林[1] 戴瑄[1] 魏红艳[1] 邹德志[1] 李慧[1] 荆小莉[1] 廖晓星[1] Hu Chunlin Dai Xuan Wei Hongyan Zou Dezhi Li Hui Jing Xiaoli Liao Xiaoxing(Department of Emergency, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510050, China)

机构地区：[1]中山大学附属第一医院急诊科,广州510080

出　　处：《中华急诊医学杂志》2017年第11期1307-1312,共6页Chinese Journal of Emergency Medicine

基　　金：广东省科技攻关计划（20138010136001）

摘　　要：目的比较急诊ICU（EICU）、内科ICU（MICU）及外科ICU（SICU）死亡患者的临床资料，分析它们的临床特点，建立合适的急诊重症患者的处理策略并为EICU的建设提供依据。方法比较2013年1月1日至2014年12月31日在中山大学附属第一医院EICU、SICU和MICU死亡患者的临床资料，其中EICU 252例、SICU 93例和MICU 80例。分析患者的临床特点，同时比较不同ICU之间家属对治疗的态度。用SPSS 13.0统计软件进行数据分析，计量资料以均数±标准差（x^-±s）表示，非正态分布计量资料以中位数（四分位数）表示；用单因素方差分析比较组间差异，样本率的比较用χ^2检验。 结果死亡患者EICU 252例，SICU 93例，MICU 80例。年龄：EICU（72±17）岁、SICU（56±17）岁、MICU（63±20）岁，EICU显著大于SICU（P〈0.01）和MICU（P〈0.01）。APACHE Ⅱ评分：EICU （33±8），SICU（34±10），MICU（29±10），EICU和SICU均高于MICU患者（P=0.01和P=0.021）。住院时间：EICU 2 d（1,46）d，SICU 14 d（1,84）d，MICU 12 d（1,77）d，EICU显著短于SICU和MICU（均P＜0.01）。住院总费用：EICU 9 777元（400,164 126）元，SICU 100 628元（13 639，964 783）元，MICU 119 463元（5 650，590 903）元，EICU明显少于SICU和MICU（均P〈0.01）。家属放弃治疗：EICU中有165例，SICU中18例，MICU中20例，EICU患者放弃治疗的比例大于SICU（P〈0.01）和MICU（P〈0.01）。EICU前5位死亡原因是严重脓毒症、脑血管意外、心源性猝死、急性心肌梗死和肿瘤晚期。结论EICU死亡患者多为老年病患者，病情严重，预后差，家属放弃治疗的比例比较高；针对严重脓毒症、严重脑卒中、心源性猝死、急性心肌梗死和肿瘤晚期等患者的主要死因, 制定相应的治疗方案、配置充足的医疗资源；及时与患者家属沟通，让家属参与终末期治疗决策，共同提高重症患者的救治成功率和有效利用EICU资�Objective To compare clinical data of the death in different intensive care unit, in order to provide the medical strategies for patients in EICU. Methods The clinical data of lethal cases from January 1, 2013 to December 31, 2014 in EICU, SICU and MICU of the First Affiliated Hospital of Sun Yat-sen University were compared. EICU （252 cases）, SICU （93 cases） and MICU （ 80 cases） were enrolled. The demographics of each patient, clinical condition such as critical score （ APACHE Ⅱ score）, length of stay, overall costs, and the patient families＇ different opinions to the treatment in each ICU were analyzed. The data was analyzed with SPSS 13.0 software, averaged value was presented as mean ＋ standard and the non-normal distributions were expressed as median （25%, 75% ）. The one-way analysis of variance was followed by the Tukey post hoc test for pairwise comparisons and chi-square test was used for comparison of percentage between two groups. Results Two hundred and fifty-two cases in EICU had gender ration of 148/96 （male/female） , 92 cases in SICU 68/24, 80 cases in MICU 56/24. Ages of the fatal were EICU 72 ± 17 years, SICU 56 ± 17 years, and MICU 63± 20 years, respectively. Age of the fatal in EICU was significantly older than that of the SICU （P 〈0. 01 ） and the MICU （P 〈0. 01 ）. APACHE 11 scores were 33 ±8 in EICU, 34 ± 10 in SICU, 29± 10 in MICU, respectively. The severity scores in EICU patients were higher than those in MICU patients and SICU patients （P =0. 01 and 0. 021 ）. Lengths of stay were 2 days （ 1, 46） in EICU, 14 days （ 1, 84） in SICU, 12 days （ 1, 77） in MICU, respectively. EICU hospitalization time was significantly shorter than that of SICU （ P 〈 0. 01 ） and the MICU （ P 〈 0. 01 ） . Total costs of hospitalization were 9 777 yuan （400, 164 126） yuan in EICU, 100 628 yuan （ 13 639, 964783） yuan in SICU, 119 463 yuan （5 650, 590 903） yuan in MICU, and that in EICU was significantly less than the total cost of

关 键 词：急诊重症监护室 死亡 患者 临床特点 

分 类 号：R459.7[医药卫生—急诊医学]