医院急危重抢救患者特点及转归现状

摘要

目的 了解上海市两所二级甲等医院急危重症抢救患者的特点及转归情况,为更加有效的分级诊疗提供依据.方法 通过文献查阅,拟定"急危重症患者抢救情况调查表",通过预调查和专家咨询,得出该调查表内在一致性Cronbach's系数为0.973.采用回顾性调查分析2017年1-9月市中心及郊区两所二级甲等医院收治的急危重症抢救患者的来源、特点及转归.结果 抢救患者的来源主要以120送入(占70.5％)与自行就诊(占29.0％)为主,其中60岁以上占68.8％,80岁以上占39.2％.疾病主要集中在心脑血管疾病、普外科、脑外科、外伤、呼吸系统,死因主要为心、脑血管疾病(占66.1％).抢救患者的转归以留观、回家与住院为主,而转入上级医院的极少(占4.9％),二级医院危重症患者的主要来源为120送入,大部分患者为老年人,就诊和抢救的疾病主要集中在心血管和脑血管疾病.结论 120救护在急危重症患者救治过程中起到非常重要的作用,有效、连续的病情预警评估能够促进分级诊疗的实施,加强二级医院医务人员的风险预警处理能力,以及老年心血管患者的管理需要不断提高.%Objective To understand the characteristics and outcomes of emergency and critically ill patients in two secondary hospitals in Shanghai, so as to provide evidence for the more efficient implementation of tiered diagnosis and treatment. Methods Through literature review, the "Survey of Emergency and Critically Ill Patients"questionnaire was formulated. Through preliminary investigation and expert consultation, the intrinsic consistency of the questionnaire was determined at 0.973 for Cronbach's. A retrospective survey was conducted to analyze the sources, characteristics, and outcomes of emergency and critically ill patients admitted to two secondary hospitals in the downtown and suburb from January to September in 2017.Results The main sources of critically ill patients were emergency admissions (70. 5％) and individual visits (29. 0％). Among them, 68. 8％ are over 60 years old, and 39.2％ are over 80 years old. The diseases mainly involved cardiovascular and cerebrovascular system, general surgery, brain surgery, trauma, and respiratory system. The primary causes of death were cardiovascular and cerebrovascular diseases. The outcomes of critically ill patients were mainly for stay-for-observation, discharge and hospitalization, and very few were transferred to higher-level hospitals. Conclusion The 120 emergency rescue and care plays an important role in treatment of critically ill patients. The effective and continuous early warning assessment system could help promote the implementation of tiered diagnosis and treatment. Medical staff's capability of early warning in secondary hospitals should be enhanced, and management of the elderly cardiovascular patients aged over 80 should be improved.