CAJ | 학술논문

目的分析ICU内严重创伤患者死亡和自动出院的变化趋势,进一步提高严重创伤的救治效果. 方法回顾性分析2003-2011年急诊ICU内死亡及自动出院严重创伤患者的临床资料.根据自动出院的状况分为濒死出院(病死人群)、病情恶化出院及好转出院,分析每年转归发生率的变化趋势,同时比较2003-2005年、2006-2008年和2009-2011年三个阶段的上述情况及总病死组、恶化出院组及总病死+恶化出院组的特征变化. 结果 (1)9年共有3 343例严重创伤患者收住急诊ICU,其中死亡231例(6.91％),包括院内死亡135例(4.04％)和濒死出院96例(2.87％);自动出院221例(6.61％),包括病情恶化出院175例(5.23％),好转出院46例(1.38％).最终452例纳入分析.(2)9年间院内病死率、濒死出院率及总病死率均呈下降趋势,恶化出院率呈上升趋势(x2=15.305,P＞0.05),但总病死+恶化出院率变化差异无统计学意义.(3)2003-2005年、2006-2008年和2009-2011年三个阶段分别收治687例、1 143例和1 513例,其中总病死组、恶化出院组、总病死+恶化出院组的年龄、急性生理与慢性健康评分Ⅱ(APACHEⅡ)升高,GCS下降.总病死率从11.06％降至4.63％(x2=31.174,P＜0.01),恶化出院率从2.77％升至6.35％(x2=12.203,P＜0.01),总病死+恶化出院率由13.83％下降至10.97％(x2=4.09,P＞0.05). 结论 2003-2011年医院急诊ICU的严重创伤救治水平呈提高趋势,恶化出院的比例增加且伴有年龄增大现象.自动出院对创伤救治效果的评价有较大影响,需引起重视.
목적 분석ICU내엄중창상환자사망화자동출원적변화추세,진일보제고엄중창상적구치효과. 방법 회고성분석2003-2011년급진ICU내사망급자동출원엄중창상환자적림상자료.근거자동출원적상황분위빈사출원(병사인군)、병정악화출원급호전출원,분석매년전귀발생솔적변화추세,동시비교2003-2005년、2006-2008년화2009-2011년삼개계단적상술정황급총병사조、악화출원조급총병사+악화출원조적특정변화. 결과 (1)9년공유3 343례엄중창상환자수주급진ICU,기중사망231례(6.91％),포괄원내사망135례(4.04％)화빈사출원96례(2.87％);자동출원221례(6.61％),포괄병정악화출원175례(5.23％),호전출원46례(1.38％).최종452례납입분석.(2)9년간원내병사솔、빈사출원솔급총병사솔균정하강추세,악화출원솔정상승추세(x2=15.305,P＞0.05),단총병사+악화출원솔변화차이무통계학의의.(3)2003-2005년、2006-2008년화2009-2011년삼개계단분별수치687례、1 143례화1 513례,기중총병사조、악화출원조、총병사+악화출원조적년령、급성생리여만성건강평분Ⅱ(APACHEⅡ)승고,GCS하강.총병사솔종11.06％강지4.63％(x2=31.174,P＜0.01),악화출원솔종2.77％승지6.35％(x2=12.203,P＜0.01),총병사+악화출원솔유13.83％하강지10.97％(x2=4.09,P＞0.05). 결론 2003-2011년의원급진ICU적엄중창상구치수평정제고추세,악화출원적비례증가차반유년령증대현상.자동출원대창상구치효과적평개유교대영향,수인기중시.
Objective To observe the variation of mortality and discharge against medical advice in major trauma patients admitted to the ICU and thus to improve the level of trauma care.Methods A retrospective analysis was performed on major trauma patients who died or discharged against medical advice in the emergency 1CU from 2003 to 2011.Patients were categorized as the dying,worse,and improved according to their situation at discharge.The dying was included into the death group.Annual variation of mortality and discharge against medical advice were analyzed in these 9 years.These parameters were also compared among three diverse periods (2003-2005,2006-2008 and 2009-2011).Results Ultimately,452 patients were recruited from the 3,343 major trauma patients admitted to the emergency ICU from 2003 to 2011.There were 231 deaths occupying 6.91％ (135 patients died in hospital and 96 patients were dying at discharge) and 221 discharges against medical advance occupying 6.61％ (175 patients deteriorated and 46 patients improved).Within the 9 years,a significant decrease was found in the annual rate of inhospital death,dying at discharge,and total death.Meanwhile,there was an increase in the rate of deterioration at discharge (x2 =15.305,P ＞0.05).However,no significant difference was found in the rate of total death plus deterioration at discharge.During the three periods of 2003 to 2005,2006 to 2008,and 2009 to 2011,number of patients admitted to the emergency ICU was 687,1,143,and 1,513 respectively.Age and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) of the dead,the patients with deterioration at discharge,and the dead plus the patients with deterioration were gradually higher through the three periods; on the contrary,GCS lowered.Total mortality decreased from 11.06％ to 4.63％ (x2 =31.174,P ＜0.01) ; rate of deterioration at discharge increased continuously from 2.77％ to 6.35％ (x2 =12.203,P ＜0.01) ; rate of death plus deterioration at discharge was declined from 13.83％ to 10.97％ (x2 =4.09,P ＞ 0.05).Conclusions From 2003 to 2011,the level of severe trauma care in emergent ICU is obviously improved.Ratio of deterioration at discharge increases with more aged patients.Discharge against medical advance interferes with the accurate assessment of trauma care and should be paid more attention.