摘要:目的:探討急診醫療過程中意外死亡的原因,以引起廣大同道的重視。方法:對急診就診過程中24 h內死亡且符合入選標準的68例患者進行死亡原因分析,分析意外死亡常見的病因并探討死亡原因與就診之初臨床特征的關系。結果:68例意外死亡患者占同期死亡人數的4.39％,其中主動脈夾層31例,占同期死亡2％,占意外死亡的45.6％;心臟性猝死(急性心肌梗塞9例,心肌炎4例,)13例占同期死亡病人的0.84％,占意外死亡總數的191％;急性腦血管病(小腦出血5例,小腦梗塞8例)13例,占同期死亡人數的0.84％,占意外死亡總數的19.1％;重癥哮喘3例;不明原因死亡5例。臨床特征多為胸痛、胸背痛、頭痛、上腹痛、眩暈等為首發癥狀。結論:急診就診過程意外死亡發生取決于多種因素,由于這些病例癥狀多不典型,病情復雜多樣,臨床醫師極易忽視,臨床極易漏診、誤診,一旦發生,都將引起較大的醫療糾紛,耗費大量的人力物力。因此對急診就診過程中的不典型特征高度重視及時考慮主動脈夾層、心臟性猝死、急性腦血管病,早期治療,避免意外死亡的發生。
Abstract: Objective: To explore the character of accidental death during treatment in emergency department, and get more attention of other emergent doctors to avoid death in emergent treatment.Methods: To analysis death causes of 68 qualified patients, who died within 24 hours after they went to hospital; To analysis familiar accidental death causes and the relationship between them and initial clinical signs. Results:These 68 accidental dead patients occupied 4.39% in all dead patients during the same period, including 31 cases of aortic dissecting hematoma(2% in all dead patients vs 45.6% in accidental dead patients); 13 cases of sudden cardiac death(0.84% in all dead patients vs 19.1% in accidental dead patients), which included 9 cases of acute myocardial infaction, 4 cases of myocarditis; 13 cases of acute cerebravascular diseases(0.84% in all dead patients vs 19.1% in accidental dead patients),which included 5 cases of cerebella hemorrhage and 8 cases of cerebella infarction; 3 severe asthma and other 5 cases without exact reasons. Clinical initial showed frequently the pain of breast, breast and back, head and upper belly, and dizzling. Conclusion: The happening of accidental death during treatment in emergent department was decided by many complicated factors. Because being nontypical and complicated, these factors always were ignored by clinical doctors, resulting wrong diagnosis or leaked diagnosis, which brought many clinical dissensions. Clinical dissensions cost much money and energy. So to know and pay more attention to these nontypical signs is very important to diagnosis aortic dissecting hematoma, sudden cardiac death and acute cerebravascular diseases, and is helpful to treat in time, and consequently the death was avoided.

Citation： XU Xiaochun,GUO Dongfeng.. The Clinical Study of 68 Cases of Sudden Death During Treatment in Emergency Department. West China Medical Journal, 2009, 24(11): 2996-2999. doi: Copy

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