CAJ | 학술논문

目的调查部分综合医院急诊科和职业病科对急性化学中毒救治的现状,为提高综合医院急性化学中毒救治能力提供依据.方法选择山东、北京、山西的4所医院其中2所为三级医院,地处市中心,由职业病科接诊市区内及郊区急性化学中毒患者；另2所为二级医院,分别地处近郊区及县城,由急诊科接诊郊区急性化学中毒患者.并对4所医院从事急性化学中毒救治的141名医护人员(急诊科组51人,职业病科组90人)进行问卷调查；分析4所医院的1999例急性化学中毒病例.通过个人深入访谈、问卷调查、现场观察等方法对比急诊科和职业病科对急性化学中毒处置能力、医护人员急性化学中毒处置的培训情况.结果急诊科组就诊患者农药中毒病例的构成比明显高于职业病科组,差异有统计学意义(P＜0.01).职业病科组急性中毒患者死亡37例,病死率为2.7％,急诊科组急性中毒患者死亡14例,病死率为2.2％,两组比较,差异无统计学意义(P＞0.05).急诊科组没有应急预案的构成比(37.3％)明显高于职业病科(10.0％),差异有统计学意义,(P＜0.01)；职业病科组急性中毒救治相关知识评分(7.2±1.3)明显高于急诊科组(5.2±0.9),差异有统计学意义(P＜0.01).急诊科组医护人员急性中毒相关知识培训和突发急性中毒事件应急处置培训的构成比明显低于职业病科组,差异有统计学意义(P＜0.05).结论综合医院急科医护人员对急性化学中毒的救治相关知识掌握欠缺,对急性化学中毒处置中防护措施认识不足,缺乏相关培训和应急预案的制定.
목적 조사부분종합의원급진과화직업병과대급성화학중독구치적현상,위제고종합의원급성화학중독구치능력제공의거.방법 선택산동、북경、산서적4소의원기중2소위삼급의원,지처시중심,유직업병과접진시구내급교구급성화학중독환자；령2소위이급의원,분별지처근교구급현성,유급진과접진교구급성화학중독환자.병대4소의원종사급성화학중독구치적141명의호인원(급진과조51인,직업병과조90인)진행문권조사；분석4소의원적1999례급성화학중독병례.통과개인심입방담、문권조사、현장관찰등방법대비급진과화직업병과대급성화학중독처치능력、의호인원급성화학중독처치적배훈정황.결과 급진과조취진환자농약중독병례적구성비명현고우직업병과조,차이유통계학의의(P＜0.01).직업병과조급성중독환자사망37례,병사솔위2.7％,급진과조급성중독환자사망14례,병사솔위2.2％,량조비교,차이무통계학의의(P＞0.05).급진과조몰유응급예안적구성비(37.3％)명현고우직업병과(10.0％),차이유통계학의의,(P＜0.01)；직업병과조급성중독구치상관지식평분(7.2±1.3)명현고우급진과조(5.2±0.9),차이유통계학의의(P＜0.01).급진과조의호인원급성중독상관지식배훈화돌발급성중독사건응급처치배훈적구성비명현저우직업병과조,차이유통계학의의(P＜0.05).결론 종합의원급과의호인원대급성화학중독적구치상관지식장악흠결,대급성화학중독처치중방호조시인식불족,결핍상관배훈화응급예안적제정.
Objective To investigate the current situation of treatment for acute chemical poisoning inthe emergency departments and occupational disease departments of some general hospitals and to provide a basis for improving the ability of general hospital to deal with acute chemical poisoning.Methods Four hospitals from Shandong Province,Beijing City,and Shanxi Province,China were selected in the study.They included two first-class hospitals located in the downtown,where the patients with acute chemical poisoning from urban and suburban areas were admitted to the occupational disease departments,and two second-class hospitals located in the suburban area or county,where the patients with acute chemical poisoning from the suburban area were admitted to the emergency departments.A questionnaire survey was conducted in 141 medical workers (51 persons in the emergence department group and 90 persons in the occupational disease department group) that were engaged in the treatment of acute chemical poisoning in the four hospitals; 1999medical records were analyzed.Individual in-depth interviews,questionnaire investigation,and field observation were used to compare the emergency department group and occupational disease department group in terms of the ability to deal with acute chemical poisoning and the training on treatment for acute chemical poisoning.Results The emergency department group had significantly higher proportion of pesticide poisoning cases than the occupational disease department group (P＜0.01).Thirty-seven of the patients in occupational disease department group died,with a fatality rate of 2.7％,and 14 of the patients in emergence department group died,with a fatality rate of 2.2％,so there was no significant difference between the two groups in this regard (P＞0.05).There were significantly more cases treated without emergency plan in the emergency department group than in the occupational disease department group (37.3％ vs.10.0％,P＜0.01).The occupational disease department group had significantly higher score of knowledge about the treatment for acute chemical poisoning than the emergence department group (7.2±1.3 vs.5.2±0.9,P＜0.01).There were significantly lower proportions of medical staff who had received training on the knowledge about acute chemical poisoning and on the emergency disposal of acute chemical poisoning in the emergency department group than in the occupational disease department group (P＜0.05).Conclusion There is a lack of the knowledge about treatment for acute chemical poisoning and protective measures during treatment among the medical staff in general hospitals,and related training and emergency plan are needed.