儿科急诊危重患儿状况调查及分析
인과급진위중환인상황조사급분석
Survey on the state of critically ill children in emergency room
  • 万方数据
    中华急诊医学杂志 중화급진의학잡지
    CHINESE JOURNAL OF EMERGENCY MEDICINE
    2012年 5期 462-466 ,共5页

    任晓旭%胡风华%曲东%牟京辉

    임효욱%호풍화%곡동%모경휘

    重症监护%急诊室%危重患儿%小儿危重病例评分%新生儿危重病例评分%格拉斯哥昏迷评分 重癥鑑護%急診室%危重患兒%小兒危重病例評分%新生兒危重病例評分%格拉斯哥昏迷評分
    중증감호%급진실%위중환인%소인위중병례평분%신생인위중병례평분%격랍사가혼미평분
    Critical care%Emergency room%Critically ill pediatric patients%PCIS%NCIS%GCS
    目的 调查分析儿科急诊危重患者状况,以期对诊治提出改进意见.方法 入急诊监护室374例危重患儿,记录来院方式、途中治疗、急诊停留时间,检测血气、生化,评估小儿/新生儿危重病例评分(PCIS/NCIS)、格拉斯哥昏迷评分(GCS),判断是否符合全身炎症反应综合征(SIRS)、脓毒症、感染性休克.结果 在374例患儿中,新生儿占29.9％,其余患儿平均年龄37.4个月.急诊停留时间4.7 h (0.42～96 h),感染性疾病47.6％.出租车、救护车、私家车为主要来院工具,分别占38.3％、28.4％、21.5％.病死率12.3％,住院病死率10.3％,急诊病死率15.6％,差异具有统计学意义(P＜0.01).PCIS/NCIS评分(81.92±9.66),危重评分≤80占44.4％、≤90占81％.172例患儿接受GCS评估,GCS≤8、9～12、13～15分别占35.5％、21.5％、43.0％.病死率为26.23％、10.81％、5.41％,差异具有统计学意义(P＜0.01).GCS≤8与13～15、GCS 9～12与13～15患儿PCIS差异具有统计学意义(P＜0.01)；GCS≤8与9～12间PCIS差异无统计学意义(P＞0.05).PCIS与GCS二者正相关(r=0.454,P=0.01),能建立直线回归(R2 =0.183,回归系数t检验P＜0.01).374例,SIRS 41.7％,脓毒症25.7％.262例非新生儿病例,休克占43.5％,61.4％为感染性休克.374例中,低血钠37.2％,高血钾22.0％.新生儿低血糖20.91％,高血糖29.1％；非新生儿低血糖9％,高血糖66.7％.pH ＜7.35的酸中毒67.8％,pH＜7.2的严重酸中毒33.1％.结论 (1)新生儿、婴幼儿占急诊危重患儿绝大部分；(2)急诊停留时间相对较短(4.7 h).急诊病死率高于住院病死率( 15.6％ vs.10.3％,P＜0.01),应积极缩短急诊停留时间,尽早住院；(3)不同交通工具来院,危重评分差异无统计学意义,使用救护车者不到1/3 (28.4％),应提高社会使用院前急救服务的意识并提高院前急救的便利性；(4)急诊PCIS/NCIS可有效评估病情与预后；重度脑功能障碍(GCS≤8)、中度脑功能障碍(GCS 8～12)共57％,非创伤性脑功能损伤在儿科急诊重患中占重要地位；(5) GCS≤8、9～12与13～15患儿的PCIS差异有统计学意义,GCS＜ 13应予重视,患儿可能处于危重状态；(6)SIRS 41.7％,脓毒症25.7％；休克占43.5％,感染性休克为主(61.4％),应重视急诊危重患儿循环、器官组织灌注状态观察与评估,以早期识别休克；(7)电解质紊乱以低血钠(37.2％)、高血钾(22.0％)最常见；高血糖(66.7％)常见,新生儿也应注意低血糖(20.91％)；酸碱平衡紊乱以酸中毒为主(67.8％),应注意相关检测及监测.
    목적 조사분석인과급진위중환자상황,이기대진치제출개진의견.방법 입급진감호실374례위중환인,기록래원방식、도중치료、급진정류시간,검측혈기、생화,평고소인/신생인위중병례평분(PCIS/NCIS)、격랍사가혼미평분(GCS),판단시부부합전신염증반응종합정(SIRS)、농독증、감염성휴극.결과 재374례환인중,신생인점29.9％,기여환인평균년령37.4개월.급진정류시간4.7 h (0.42～96 h),감염성질병47.6％.출조차、구호차、사가차위주요래원공구,분별점38.3％、28.4％、21.5％.병사솔12.3％,주원병사솔10.3％,급진병사솔15.6％,차이구유통계학의의(P＜0.01).PCIS/NCIS평분(81.92±9.66),위중평분≤80점44.4％、≤90점81％.172례환인접수GCS평고,GCS≤8、9～12、13～15분별점35.5％、21.5％、43.0％.병사솔위26.23％、10.81％、5.41％,차이구유통계학의의(P＜0.01).GCS≤8여13～15、GCS 9～12여13～15환인PCIS차이구유통계학의의(P＜0.01)；GCS≤8여9～12간PCIS차이무통계학의의(P＞0.05).PCIS여GCS이자정상관(r=0.454,P=0.01),능건립직선회귀(R2 =0.183,회귀계수t검험P＜0.01).374례,SIRS 41.7％,농독증25.7％.262례비신생인병례,휴극점43.5％,61.4％위감염성휴극.374례중,저혈납37.2％,고혈갑22.0％.신생인저혈당20.91％,고혈당29.1％；비신생인저혈당9％,고혈당66.7％.pH ＜7.35적산중독67.8％,pH＜7.2적엄중산중독33.1％.결론 (1)신생인、영유인점급진위중환인절대부분；(2)급진정류시간상대교단(4.7 h).급진병사솔고우주원병사솔( 15.6％ vs.10.3％,P＜0.01),응적겁축단급진정류시간,진조주원；(3)불동교통공구래원,위중평분차이무통계학의의,사용구호차자불도1/3 (28.4％),응제고사회사용원전급구복무적의식병제고원전급구적편리성；(4)급진PCIS/NCIS가유효평고병정여예후；중도뇌공능장애(GCS≤8)、중도뇌공능장애(GCS 8～12)공57％,비창상성뇌공능손상재인과급진중환중점중요지위；(5) GCS≤8、9～12여13～15환인적PCIS차이유통계학의의,GCS＜ 13응여중시,환인가능처우위중상태；(6)SIRS 41.7％,농독증25.7％；휴극점43.5％,감염성휴극위주(61.4％),응중시급진위중환인순배、기관조직관주상태관찰여평고,이조기식별휴극；(7)전해질문란이저혈납(37.2％)、고혈갑(22.0％)최상견；고혈당(66.7％)상견,신생인야응주의저혈당(20.91％)；산감평형문란이산중독위주(67.8％),응주의상관검측급감측.
    Objective To survey on the condition of critically ill children in emergency room (ER) for improving the care for them.Methods Data of 374 critically ill children in emergency intensive care unit (EICU) were recorded in the respects of mode of sending them to ER,rescue during transport,length of stay in ER,blood gas,electrolytes,accuracy of assessing pediatric critical illness score/neonate critical illness score (PCIS/NCIS) and Glasgow Coma Scale (GCS),correctness of determining SIRS,sepsis and septic shock.Results Of 374 patients,neonates were 29.9％,and the mean age of children patients not including neonate was 37.4 months.The mean length of ER stay was 4.7 hours (0.42-96 hours).Of 374 patients,those with infection diseases were 47.6％,and the main vehicles for transportation of patient sent to ER were Taxi (38.3％),ambulance (28.4％) and private cars (21.5％).Total fatality was 12.3％ and ER fatality ( 15.6％ ) was higher than in - hospital fatality ( 10.3％,P ＜0.01 ).The mean PCIS/NCIS of 374 patients were 81.92 ± 9.66,and the PCIS/NCIS ≤ 90 accounted for 81％.Of assessed GCSs of 172 patients,GCS≤8,GCS 9-12 and GCS 13-15 accounted for 35.5％,21.5％ and 43.0％ respectively,and fatalities were 26.23％,10.81％ and 5.41％ correspondingly (P ＜0.01 ).The PCIS values of GCS≤8 and GCS 9-12 patients were lower than those of GCS 13-15 patients (P ＜ 0.01 ).There was no significant difference in PCIS between GCS≤8 and GCS 9-12 ( P ＞ 0.05 ).PCIS and GCS were positively correlated (r=0.454,P=0.01).Of374 patients,41.7％ had SIRS,and 25.7％ had sepsis.Of 262 children not including neonates,43.5％ had shock,and 61.4％ of these shock children were septic shock.In 374 patients,those with hyponatremia accounted for 37.2％,and those with hyperkaliemia accounted for 22.0％.The rate of hypoglycemia found in neonates was 20.91％ and rate of hyperglycemia occurred in neonates was 29.1％.The rate of hypoglycemia found in children patients was 9％ and hyperglycemia was 66.7％.Patients with pH ＜ 7.35 accounted for 67.8％ and those with pH ＜ 7.2 were 33.1％.Conclusions The majority of children patients in pediatric ER were neonates and infants.The length of ER stay was short with mean value of 4.7 hours (0.42-96 hours).ER fatality was higher than in - hospital fatality,suggesting the critically ill children patients should be admitted as early as possible.The rate of using ambulance was only 28.4％.The Emergency Medical Service (EMS) should be improved to enhance the public sense of the EMS available.PCIS/NCIS can be used in ER for assessing the conditions and prognosis of critically ill children.GCS ≤8 and GCS 8-12 patients accounted for 57％ with majority of nontrauma brain injury.The values of PCIS in GCS≤8 and GCS 9-12 patients were much lower than those in GCS 13-15 patients.Patients with GCS ＜ 13 might be in critical settings.Majority of shock patients were septic shock (61.4％).Hyponatremia,hyperkalemia,hyperglycemia and hypoglycemia often occurred in critically ill pediatric patients and hypoglycemia not excepted in the neonates should have attention paid to.The main factor of acid -base balance disorder in critically ill children was acidosis (67.8％).
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문