呼吸衰竭患者入急诊抢救室时机与疾病预后的相关性研究

摘要

目的：探讨呼吸衰竭患者进入急诊抢救室的时机与患者预后的相关性。方法：选取我院2011年6月至2014年3月收治的97例呼吸衰竭患者，根据入院时间分为观察组（58例）和对照组（39例），观察组患者为法定工作时间进入急诊室抢救的患者，对照组为非法定工作时间进入抢救室的患者，比较两组患者的入院生理指标及抢救成功率差异；并根据入院时的急性生理与慢性健康评分（A-PACHEⅡ）进行分及患者转归进行分层分析。结果：观察组和对照组患者的年龄、性别、血PH值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、血液中乳酸含量、APACHEⅡ评分、D－二聚体、纤维蛋白原（ Fib）、死亡率差异均不具有统计学意义（ P＞0．05）。97例患者存活77例，抢救无效死亡20例，存活组和死亡组的血PH值、PaO2、PaCO2、血液中乳酸含量、APACHEⅡ评分、D－二聚体、Fib差异均具有显著性，差异具有统计学意义（ P＜0．05）。 APACHEⅡ评分＜20分的观察组和对照组患者的死亡率差异不显著（P＞0．05）；APACHEⅡ评分≥20分的对照组患者死亡率46．67％高于对观察组的14．81％，差异具有统计学意义（ P＜0．05）。结论：APACHEⅡ评分＜20分的呼吸衰竭患者入急救室时机对患者的转归无影响，但APACHEⅡ评分≥20分的患者，入院时机会对患者结局产生影响，应该采取相应措施降低因入院时机造成的患者不良结局。%Objective:To discuss the correlation between the timing and prognosis of the patients with respiratory failure in the emergency resuscitation room .Method:Selected 97 cases of patients with respiratory failure on admission from Jun .2011 to Mar.2014 in our hospital, and divided them into observation group (58 cases) and control group (39 cases) according to the admission time ,the patients of observation group was the statutory working hours into the emergency room , the patients of control group was not the statutory working hours into the resuscitation room , compared two groups of patients admitted to hospital physiologicalindexes and success rate of rescue ,and according to the hospital at the time of the acute physiology and chro-nic health evaluation ( APACHE Ⅱ) points and outcome for patients with hierarchical analysis .Result:The age, sex, blood pH, arterial blood oxygen partial pressure , arterial blood ( PaO2 ) CO2 partial pressure (PaCO2), blood lactate levels and APACHE Ⅱrating, D -dimer, fibrinogen (Fib), mortality differences in two groups were not statistically significant ( P>0.05) .77 cases of patients were survived , 20 cases were rescue died in the 97 cases of patients,the survival group and the death group of blood pH value , PaO2, PaCO2, blood lactate concentration, APACHEⅡ score, D-dimer, Fib had significant differences, the difference had statistically significant ( P <0.05) .APACHEⅡscore <20 points in the observation group and control group patients'mortality had not significant difference (P>0.05); APACHEⅡscore ≥20 points of mortality in the control group ( 46.67%) was higher than the observation group ( 14.81%) ,the difference had statistically significant ( P <0.05 ) .Conclusoi n:It has not effect for patients with respiratory failure outcomes APACHE Ⅱscore <20 points into the emergency room , but patients with APACHE Ⅱscoring≥20 points have admission opportunity impact outcomes , it should take appropriate measures to reduce due to the timing of admission caused adverse outcomes in patients .