急诊成年猝死患者201例流行病学调查及白细胞计数、乳酸浓度对预后的影响  

Epidemiological investigation of 201 emergency adult sudden death patients and analysis of the influence of leukocyte count and lactic acid concentration on prognosis

作　　者：武小娟 孟舰 刘红新 王雅莉 王莹 高莹 李彦国[2] Wu Xiaojuan;Meng Jian;Liu Hongxin;Wang Yali;Wang Ying;Gao Ying;Li Yanguo(Department of Emergency,Cangzhou People's Hospital,Hebei Province,Cangzhou 061000,China;Teaching and Research Section of Preventive Medicine,Cangzhou Medical College,Cangzhou 061000,China)

机构地区：[1]河北省沧州市人民医院医专院区急诊科,沧州061000 [2]河北省沧州医学高等专科学校预防医学教研室,沧州061000

出　　处：《中国综合临床》2022年第6期527-533,共7页Clinical Medicine of China

基　　金：河北省医学科学研究课题(20211775)。

摘　　要：目的分析201例急诊成年猝死患者的临床资料,并研究白细胞计数、动脉血乳酸浓度对预后的影响。方法回顾性分析2017年1月至2021年1月河北省沧州市人民医院医专院区急诊科诊断为猝死的201例患者临床资料,对患者性别、年龄、疾病构成、病因等进行统计分析。符合正态分布的计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ^(2)检验或Fisher确切概率法,采用Logistic回归模型筛选急诊死亡的危险因素,并分析白细胞计数、动脉血乳酸水平对预后的影响。结果经过积极抢救,抢救成功11.44%(23/201),抢救无效88.56%(178/201);≥46~≤65岁为猝死高发年龄段[55.22%(111/201)],≥46~≤65岁年龄段及>65岁年龄段内,男性占比[43.28%(87/201)、20.90%(42/201)]均高于女性[11.94%(24/201)、14.43%(29/201)],差异有统计学意义(χ^(2)值分别为4.801、9.209;P值分别为0.028、0.002);猝死患者既往史中,心血管疾病占比[53.23%(107/201)]最高;猝死前可能存在诱因患者占比74.13%(149/201),猝死前有先兆症状的患者占比67.66%(136/201),心源性猝死为首位病因;Logistic回归分析显示,白细胞计数(OR=4.442,95%CI:1.898~10.395)、动脉血乳酸浓度(OR=4.272,95%CI:2.024~9.016)、白蛋白浓度(OR=2.657,95%CI:1.302~5.422)是影响急诊猝死患者的独立危险因素(P值分别为0.001、<0.001、0.007)。结论成人猝死患者在性别、年龄、既往史方面存在一定差异,多数存在先兆症状与诱因,心源性猝死为首要病因。白细胞计数及动脉血乳酸浓度升高、白蛋白浓度降低是急诊患者猝死的危险因素。Objective To investigate the clinical situation of 201 emergency adult sudden death patients,and analyze the influence of white blood cell count and arterial blood lactate level on prognosis.Methods The clinical data of 201 patients diagnosed with sudden death in the emergency department of Medical College of Cangzhou people's Hospital from January 2017 to January 2021 were retrospectively analyzed.The gender,age,disease composition and etiology of the patients were statistically analyzed.The independent sample t-test was used to compare the measurement data with normal distribution,theχ^(2) test or Fisher exact probability method was used to compare the counting data between groups,and the logistic regression model was used to screen the risk factors of emergency death,and the impact of white blood cell count and arterial blood lactate level on the prognosis was analyzed.Results After active rescue,11.44%(23/201)of the patients were successfully rescued,and 88.56%(178/201)of the patients were ineffective;≥46-≤65 years old was the age group with high incidence of sudden death(55.22%(111/201)).The proportion of male(43.28%(87/201),23.38%(42/201))in the age group of≥46-≤65 years old and the age group over 65 years old were higher than that of female(11.94%(24/201),14.43%(29/201)),with a statistically significant difference(χ^(2)=4.801,9.209;P=0.028,0.002).In the past history of sudden death patients,the proportion of cardiovascular disease(53.23%(107/201))was the highest;the proportion of patients may have inducements before sudden death was 74.13%(149/201),the proportion of patients have premonitory symptoms before sudden death was 67.66%(136/201),and sudden cardiac death was the first cause.Logistic regression analysis showed that white blood cell count(OR=4.442,95%CI:1.898-10.395),arterial blood lactic acid concentration(OR=4.272,95%CI:2.024-9.016),and albumin concentration(OR=2.657,95%CI:1.302-5.422)were independent risk factors affecting emergency sudden death patients(P values were 0.001,<0.001,0.00

关 键 词：猝死 白细胞计数 乳酸 急诊 预后分析 

分 类 号：R459.7[医药卫生—急诊医学]