发热患者医院内突发死亡的早期识别及预防措施的临床分析  

Clinical analysis of the fever patients about early identification and precautionary measures of sudden death in hospital

作　　者：李刚[1] 张可[1] 韩楠楠[1] LI Gang;ZHANG Ke;HAN Nan-nan(Department of Euergoncy,Zhejiang Province People's Hospital,the Affiliated People's Hospital of Hangzhou Medical College,Hangzhou,Zhejiang 310014,China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院急诊科,浙江杭州310014

出　　处：《中华全科医学》2020年第3期501-504,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2015KYB034)。

摘　　要：目的统计分析以发热为起始症状的患者在院内出现心脏骤停前的共同特征,探讨如何早期识别及预防发热患者院内发生心脏骤停。方法通过电子病历数据库收集2008年1月1日-2018年10月31日以发热为首发症状于浙江省人民医院急诊留观期间突发死亡的患者32例。统计患者发病前、入院时、突发死亡前1 h的数据资料,包括患者血钠、血钾、酸中毒的改变及程度,有无乳酸增高及程度;患者的生命体征,包括呼吸、心率、血压、经皮氧饱和度;患者的意识状态,治疗经过,包括是否使用退热药物,使用退热药物后静脉补充液体量,治疗过程中是否认为合并急性心力衰竭且使用过利尿剂。通过分析以上数据,总结发热患者院内突发死亡前的共同特性。结果所有患者均有不同程度的意识改变,81.25%的患者使用过退热药物,且用药后只有1位患者补液量达1 000 mL,同时误认为合并急性心衰静脉使用利尿剂7人,占比21.88%。心脏骤停前1 h患者心率较发病前及入院时均明显增快,心率增快与体温增加不成比例,呼吸频率明显增快,而血压、经皮氧饱和度改变差异无统计学意义。患者心脏骤停前1 h pH、BE、血乳酸均明显改变,以钾离子为顶,钠离子和酸中毒为底的莫尔死亡征发生率明显增加。结论通过患者的生命体征及检验结果改变,可以早期发现、预防发热患者在院内突发死亡;通过统计该类患者的治疗经过,减少有可能增加突发死亡风险的医疗干预,降低该类患者院内突发死亡的发生率。Objective Statistical analysis of common features of cardiac arrest in patients with fever, to study the early identification and prevention of cardiac arrest in patients with fever. Methods Retrospective review of 32 cases of fever was the first symptom from 2008 January to 2018 October in Zhejiang Province People’s Hospital through the electronic medical record database. Those included the data of before the fever, arrived at the hospital, 1 hour before sudden death, the change of Na+, K+, PH, Lac, breathing frequency, heart rate, blood pressure, SPO2, consciousness, treatment, antipyretic drugs, volume of liquid, ever used diuretics. Through the analysis of the above data, the common characteristics of patients with fever before sudden death in hospital were summarized. Results The change of conscious were happened in all patients, 81.25% of patients have used different types of antipyretic drugs, only one patient Intravenous fluid supplementation 1 000 mL after antipyretic drug, seven peoples ever used diuretics, 21.88%. The heart rate of 1 hour before sudden death increased significantly compared to before the fever and arrived at the hospital, and sinus arrhythmia, increased heart rate was not proportional to increased body temperature. Breathing frequency increased significantly. No significant difference between blood pressure and SPO2. The PH,BE, Lac of 1 hour before sudden death increased significantly compared to before the fever and arrived at the hospital. No significant difference between Na+ and K+. The incidence of "Moore’s death"(A triangle of Na+, K+ and PH) was significantly increased. Conclusion Sudden death in hospital of Fever patient has very high risk of doctor-patient disputes, early detection and prevention through the changes in the patient’s vital signs and test results. These results may help us reduce medical interventions that may increase the risk of sudden death and deduce the incidence of sudden hospital deaths in such patients.

关 键 词：发热 医院内 心脏骤停 死亡 早期识别 预防措施 

分 类 号：R441.3[医药卫生—诊断学] R541.78[医药卫生—临床医学]