目的 探讨近年急诊抢救室患者7 d全因死亡临床特征及影响因素和预警指标,为临床救治提供依据.方法 收集2022年1-12月辖区三级医疗单位急诊抢救室收治的患者2 480例,统计7 d全因死亡发生情况,同时分析死亡和存活患者临床资料差异,分析其影响因素和预警指标.结果 7 d全因死亡患者760例,7 d全因死亡发生率为30.65％;死亡原因分布中:以心脑血管疾病、外伤为主,分别占42.63％和24.74％;死亡患者年龄、体温、白细胞(white blood cell,WBC)计数、凝血酶原时间(prothrombin time,PT)、血尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,Scr)、血糖、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、英国国家早期预警评分(British National Early Warning Score,NEWS)、急性生理和慢性健康状况评分 Ⅱ(Acute Physiology and Chronic Health Evaluation,APACHE Ⅱ)、序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA),分别为(65.56± 21.41)岁、(37.89±1.21)℃、(12.21±2.21)× 109/L、(16.54±8.45)s、(9.89±4.60)mmol/L、(80.05±34.18)μmol/L、(13.10± 4.12)mmol/L、(76.61±21.80)U/L、(72.26±18.84)U/L、(12.40±4.32)分、(27.45±9.84)分和(13.35±5.11)分,均明显高于存活患者(P＜0.05),而血红蛋白(hemoglobin,Hb)为(120.24±28.89)g/L,明显低于存活患者(P＜0.05);多因素logistic回归分析结果显示:年龄、NEWS、APACHE Ⅱ和SOFA是急诊抢救室患者死亡的影响因素(P＜0.05);NEWS、APACHE Ⅱ、SOFA预测患者死亡的受试者工作特征(receiver operating characteristic,ROC)曲线下面积分别为0.722、0.789和0.742,三者预测患者死亡的价值差异无统计学意义(P＞0.05).结论 近年急诊抢救室患者7 d全因死亡主要以心脑血管疾病、外伤为主,死亡影响因素包括患者年龄、NEWS、APACHE Ⅱ和SOFA,其中NEWS、APACHE Ⅱ和SOFA预测患者死亡具有一定价值.
Clinical characteristics,influencing factors and early warning indicators of 7-day all-cause mortality among patients in emergency rescue rooms
Objective To explore the clinical characteristics,affecting factors and early warning indicators of 7-day all-cause death among patients in emergency rescue rooms in recent years so as to provide a basis for clinical practice.Methods We collected 2,480 patients admitted to emergency rescue rooms of tertiary medical institutions within the jurisdiction from January 2022 to December 2023,statistically analyzed the occurrence of all-cause death within 7 days,simultaneously explored the differences in clinical data between dead and surviving patients,and identified their influencing factors and early warning indicators.Results Seven hundred and sixty patients died from all causes within 7 days,with a 7-day all-cause mortality rate of 30.65％.In the distribution of causes of death,cardiovascular and cerebrovascular diseases and trauma were the main causes,accounting for 42.63％and 24.74％respectively.The dead patients'age,body temperature,white blood cell(WBC)count,prothrombin time(PT),blood urea nitrogen(BUN),serum creatinine(Scr),blood glucose,alanine aminotransferase(ALT),aspartate aminotransferase(AST),British National Early Warning Score(NEWS),Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score,and Sequential Organ Failure Assessment(SOFA)score were(65.56±21.41)years old,(37.89±1.21)℃,(12.21±2.21)×109/L,(16.54±8.45)s,(9.89±4.60)mmol/L,(80.05±34.18)μmol/L,(13.10± 4.12)mmol/L,(76.61±21.80)U/L,(72.26±18.84)U/L,(12.40±4.32)points,(27.45±9.84)points and(13.35±5.11)points respectively,which were significantly higher than those of the surviving patients(all P＜0.05),but the dead patients'hemoglobin((120.24±28.89)g/L)was significantly lower than that of the surviving patients(P＜0.05).The results of multivariate logistic regression analysis showed that age,NEWS score,APACHE Ⅱ score,and SOFA score were the factors influencing mortality among the patients in emergency rescue rooms(P＜0.05).The areas under the receiver operating characteristic(ROC)curves predicted by NEWS score,APACHE Ⅱ score,and SOFA score for patient death were 0.722,0.789 and 0.742 respectively.There was no significant difference in the predictive values of the three scores for patient death(P＞0.05).Conclusion In recent years,the leading causes of 7-day all-cause death among the patients in emergency rescue rooms are cardiovascular and cerebrovascular diseases and trauma.The factors influencing death include the patients'age,NEWS score,APACHE Ⅱ score and SOFA score,of which NEWS score,APACHE Ⅱ score and SOFA score have certain values in predicting patient death.
NETL
NSTL
万方数据
