CAJ | 학술논문

目的通过分析一组急诊成人意识状态改变(AMS)病例,了解其人口学特征、临床评估方法、病因构成情况、临床预后,及潜在急诊干预策略.方法前瞻性队列观察研究,分析一家大型临床教学医院急诊科2009年6月至2011年6月两年间AMS病例,收集其人口学特征、临床表现、评估方法、干预措施、预后等数据.结果共1934例AMS患者纳入本研究,占急诊总病例数的0.93％,其中男性1026例(53.1％),女性908例(46.9％)；年龄(51.95 ±15.71)岁,患者年龄分布频率呈双峰型.AMS主要致病因素包括原发神经系统(641例,35.0％)、药物和中毒(421例,23.0％)、感染(167例,9.1％)、代谢/内分泌(145例,7.9％),而不同年龄组病因构成差异具有统计学意义.急诊AMS总病死率为8.1％(156例),老年人组中病死率更高(10.8％ vs.6.9％,P=0.003).结论原发神经系统事件、药物和中毒、系统或脏器功能损伤、代谢内分泌异常是急诊AMS常见致病因素.急诊AMS有很高的病死率,AMS是急诊患者重要的警示信号,因其潜在致命和病情的可逆性,需要急诊医师进行快速评估,及时采取挽救生命干预措施.
목적 통과분석일조급진성인의식상태개변(AMS)병례,료해기인구학특정、림상평고방법、병인구성정황、림상예후,급잠재급진간예책략.방법 전첨성대렬관찰연구,분석일가대형림상교학의원급진과2009년6월지2011년6월량년간AMS병례,수집기인구학특정、림상표현、평고방법、간예조시、예후등수거.결과 공1934례AMS환자납입본연구,점급진총병례수적0.93％,기중남성1026례(53.1％),녀성908례(46.9％)；년령(51.95 ±15.71)세,환자년령분포빈솔정쌍봉형.AMS주요치병인소포괄원발신경계통(641례,35.0％)、약물화중독(421례,23.0％)、감염(167례,9.1％)、대사/내분비(145례,7.9％),이불동년령조병인구성차이구유통계학의의.급진AMS총병사솔위8.1％(156례),노년인조중병사솔경고(10.8％ vs.6.9％,P=0.003).결론 원발신경계통사건、약물화중독、계통혹장기공능손상、대사내분비이상시급진AMS상견치병인소.급진AMS유흔고적병사솔,AMS시급진환자중요적경시신호,인기잠재치명화병정적가역성,수요급진의사진행쾌속평고,급시채취만구생명간예조시.
Objective To provide a framework for understanding the need for a structured assessment of altered mental status (AMS) to better understand underlying causes of the mental status changes in adults and therefore potentially improve diagnostic skills and eventually management.Methods This is a prospective cohort observational study.We recruited consecutive adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months.Demographical,clinical presentations,assessment approaches,cause factors,emergency treatments and outcomes were collected prospectively.Results One thousand nine hundred and thirty-four patients with AMS were recruited,this number of patients represented 5％ of the total ED census.Out of 1934 patients,1026 (53.1％) were male,908 (46.9％) were female.Mean age was (51.95 ± 15.71) years.Etiologic factors included neurological (n =641,35.0％),pharmacologic & toxicologic (n =421,23.0％),systemic and organic (n =266,14.5％),infectious (n =167; 9.1％),endocrine/metabolic (n =145,7.9％),psychiatric (n =71,3.9％),traumatic (n =38,2.1％),gynecologic and obstetric (n =35,1.9％).Total mortality rate was 8.1％ (n =156).The death rate was higher in elderly patients (≥ 60) than that in younger patients (10.8％ vs.6.9％,P =0.003).Conclusions The patient with AMS poses a challenge to physicians in ED.The most frequently encountered diagnostic category causing AMS were primary CNS disorders,intoxication,organ system dysfunction and endocrine/metabolic diseases.Fatality rate is very high.Prompt evaluation and treatment are essential to decrease the morbidity and mortality associated with this condition.