急诊死亡患者临床特征的研究

目的：探讨大型综合性医院急诊抢救死亡患者的临床特征。方法：对1880例急诊临床死亡患者的临床特征进行回顾性分析,主要内容包括年龄、性别、既往病史、首发症状、来诊方式、来诊时间和死因诊断等。结果：①本组前五位死亡原因为原因不明死亡（42.23%）,创伤（17.61%）、脑血管疾病（15.32%）、心血管疾病（7.34%）和恶性肿瘤晚期（4.30%）;②创伤死亡患者的男性明显高于女性（男/女：261/70）,也显著高于其他各组（均P〈0.01）;③原因不明死亡、心血管系统疾病、脑血管疾病和恶性肿瘤晚期的急诊死亡年龄特征呈增龄变化,而创伤急诊死亡高峰年龄段在15～30岁（38.37%,127/331）;④发病至就诊时间〈1h为59.04%（1110/1880）,全部死亡患者中由120送诊的只有29.08%（528/1880）。⑤发病至死亡时间〈1h的为39.89%（750/1880）,不明原因患者在发病1h内急诊死亡占66.25%（526/794）,高于创伤（41.69%,138/331）,且差异有统计学意义（χ2=58.239,P〈0.01）。结论：急诊抢救死亡多为发病后〈1h就诊,发病至死亡〈1h,和死亡原因不明的,和非120送诊的患者,这提示加强急诊患者最初的诊治尤为重要。

Study on the clinical characteristics of death patients in the emergency department

Objective：To investigate the clinical characteristics of death patients in the emergency department（ED） of a large general hospital.Method：The data including the age,gender,past history,symptom,time to visit hospital,and death cause diagnosis were collected and analyzed in the 1 880death cases in the emergency department.Result：①The top five death causes were listed as death with unknown cause（42.23%）,trauma（17.61%）,cerebrovascular diseases（15.32%）,cardiovascular diseases（7.34%） and advanced stage of malignant tumors（4.30%）.②The male patients were predominated in the trauma caused death patients（male /female：261 /70）,and the M-F ration was also significantly higher in other death cause groups（All P0.01）.③The mortality rate with unknown cause,cerebrovascular diseases,cardiovascular diseases and advanced stage of malignant tumors was increased with age,while the age of trauma caused death patients peak between 15to 30years（38.37%,127 /331）.④ED death patients with the duration from the onset to visiting ED less than 1haccount for 59.04%（1110 /1 180）,and only 29.08%（528 /1 880） patients were sent to hospital by EMS.⑤39.89%（750 /1 880） patients were dead in one hour from the onset in the total ED death patients ;And 66.25%（526 /794） patients died in less than one hour with the unknown causes,which were significantly higher than the trauma patients（41.69%,138 /331 ;χ 2 =58.239,P0.0 1）.Conclusion：The clinical characteristics of ED death patients including visiting hospital in one hour from the onset,duration between the onset to death less than one hour,the death cause unknown,and the patients send not by EMS suggest the early diagnoses and treatment in the ED should be strengthened.