摘要目的 比较急诊ICU (EICU)、内科ICU (MICU)及外科ICU (SICU)死亡患者的临床资料,分析它们的临床特点,建立合适的急诊重症患者的处理策略并为EICU的建设提供依据.方法 比较2013年1月1日至2014年12月31日在中山大学附属第一医院EICU、SICU和MICU死亡患者的临床资料,其中EICU 252例、SICU 93例和MICU 80例.分析患者的临床特点,同时比较不同ICU之间家属对治疗的态度.用SPSS 13.0统计软件进行数据分析,计量资料以均数±标准差(x-±s)表示,非正态分布计量资料以中位数(四分位数)表示;用单因素方差分析比较组间差异,样本率的比较用x2检验.结果 死亡患者EICU 252例,SICU 93例,MICU 80例.年龄:EICU (72± 17)岁、SICU (56±17)岁、MICU (63±20)岁,EICU显著大于SICU(P＜O.O1)和MICU (P＜0.01). APACHEⅡ评分:EICU (33 ±8),SICU (34±10),MICU (29±10),EICU和SICU均高于MICU患者(P=0.01和P=0.021).住院时间:EICU 2 d(1,46)d,SICU 14 d(1,84)d,MICU 12 d(1,77)d,EICU显著短于SICU和MICU(均P＜0.01).住院总费用:EICU 9 777元(400,164 126)元,SICU 100 628元(13 639,964 783)元,MICU119 463元(5 650,590 903)元,EICU明显少于SICU和MICU(均P＜0.01).家属放弃治疗:EICU中有165例,SICU中18例,MICU中20例,EICU患者放弃治疗的比例大于SICU (P＜O.01)和MICU (P＜0.01).EICU前5位死亡原因是严重脓毒症、脑血管意外、心源性猝死、急性心肌梗死和肿瘤晚期.结论 EICU死亡患者多为老年病患者,病情严重,预后差,家属放弃治疗的比例比较高;针对严重脓毒症、严重脑卒中、心源性猝死、急性心肌梗死和肿瘤晚期等患者的主要死因,制定相应的治疗方案、配置充足的医疗资源;及时与患者家属沟通,让家属参与终末期治疗决策,共同提高重症患者的救治成功率和有效利用EICU资源.

abstractsObjective To compare clinical data of the death in different intensive care unit,in order to provide the medical strategies for patients in EICU.Methods The clinical data of lethal cases from January 1,2013 to December 31,2014 in EICU,SICU and MICU of the First Affiliated Hospital of Sun Yat-sen University were compared.EICU (252 cases),SICU (93 cases) and MICU (80 cases) were enrolled.The demographics of each patient,clinical condition such as critical score (APACHE Ⅱ score),length of stay,overall costs,and the patient families' different opinions to the treatment in each ICU were analyzed.The data was analyzed with SPSS 13.0 software,averaged value was presented as mean ± standard and the non-normal distributions were expressed as median (25％,75％).The one-way analysis of variance was followed by the Tukey post hoc test for pairwise comparisons and chi-square test was used for comparison of percentage between two groups.Results Two hundred and fifty-two cases in EICU had gender ration of 148/96 (male/female),92 cases in SICU 68/24,80 cases in MICU 56/24.Ages of the fatal were EICU 72 ± 17 years,SICU 56 ± 17 years,and MICU 63 ± 20 years,respectively.Age of the fatal in EICU was significantly older than that of the SICU (P ＜ 0.01) and the MICU (P ＜ 0.01).APACHE Ⅱscores were 33 ± 8 in EICU,34 ± 10 in SICU,29 ± 10 in MICU,respectively.The severity scores in EICU patients were higher than those in MICU patients and SICU patients (P =0.01 and 0.021).Lengths of stay were 2 days (1,46) in EICU,14 days (1,84) in SICU,12 days (1,77) in MICU,respectively.EICU hospitalization time was significantly shorter than that of SICU (P ＜ 0.01) and the MICU (P ＜ 0.01).Total costs of hospitalization were 9 777 yuan (400,164 126) yuan in EICU,100 628 yuan (13 639,964 783) yuan in SICU,119 463 yuan (5 650,590 903) yuan in MICU,and that in EICU was significantly less than the total cost of hospitalization in SICU (P ＜ 0.01) and in MICU (P ＜ 0.01).The opinion of patient families was proposed to give up treatment associated with 165 dead cases in EICU,18 death cases in SICU and 20 dead cases in MICU,and the rate of discontinuous treatment in EICU patients was significantly greater than that in SICU (P ＜ 0.01) and in MICU (P ＜ 0.01).There were no significant differences in invasive procedures,invasive hemodynamic monitoring,mechanical ventilation,blood purification and deep vein puncture among three groups.The 5 leading causes in EICU were severe sepsis,stroke,sudden cardiac arrest,acute myocardial infarction and advanced malignancy.Conclusions The death of patients were due to advanced age with severe disease,poor prognosis,and the request of patient family members to give up treatment.The 5 leading causes were severe sepsis,stroke,sudden cardiac arrest,acute myocardial infarction and advanced tumors suggesting the establishment of corresponding treatment scheme to be made and preparation of abundant medical resources to be ready.Timely communication with the patients' families and let them participate in end-stage treatment decisions was the best strategies to improve the successful rate of treating severe patients and use EICU resource effectively.