【摘要】 目的 分析地市级急救中心院前急救中损伤患者临床特点，科学地指导院前急救诊断处置及急诊外科资源配置。 方法 回顾性分析2009年1-12月份自贡市急救中心出诊的全部有效病例中损伤患者出诊资料，分析其疾病谱、季节、月份、时刻分布特点。 结果 全年院前急救损伤患者共1 922例，排名前5位的分别为:头部损伤，涉及身体多个部位的损伤，膝和小腿损伤，腹部、背、腰椎和骨盆损伤，髋和大腿损伤，所有分类构成比男性均多于女性；损伤季节分布以冬季较多（Plt;0.05）；分布以1、11、12月份为多；时刻分布以凌晨0:00~6:00为出诊最少时段。 结论 国际疾病分类（ICD-10）为规范院前急救疾病谱提供参考，根据损伤类疾病谱可确定急诊外科工作及发展重心，依据季节、月份及时刻分布特点能指导急救资源合理配置。【Abstract】 Objective To provide scientific guidance of assistances for patients sustaining injuries and of effective resource allocation of emergency surgery by analyzing the pre-hospital features of injuries in urgent rescue centers at the local or city level. Methods All cases of injuries in pre-hospital emergency care during the year of 2009 were studied. The spectrum of diseases, and the seasons, the months, and the time points of the diseases were analyzed. Results There were totally 1 922 patients of pre-hospital emergency care in the whole year. Based on the International Classification of Diseases 10th Revision (ICD-10), top five classifications were injuries to the head, injuries involving multiple body regions, injuries to the knee and lower leg, injuries to the abdomen, lower back, lumbar spine and pelvis, and injuries to the hip and thigh. For all kinds of injuries, the number of male patients was more than that of the female. The cases in winter were more than those in other seasons (Plt;0.05). The cases in January, November and December were more than those in other months. The cases between 0:00 am and 6:00 am were less than those at other time points. Conclusion ICD-10 could provide reference for standardizing the spectrum of diseases in pre-hospital care. The focus of emergency surgery may be guided by the spectrum of injuries. The features of the season, the month, and time point of diseases can offer practical help for resource allocation in pre-hospital care.
【摘要】 目的 研究自贡市急救中心院前急救流行病学特征。 方法 回顾性分析2009年度自贡市急救中心出诊的院前急救数据，研究院前急救疾病谱及性别、年龄构成，并分析时刻及季节分布特点，描述院前急救转归。 结果 2009年度自贡市急救中心院前急救共4 588例，排前6位疾病依次为损伤、中毒和外因的某些其他后果（45.6%），循环系统疾病（15.0%），呼吸系统疾病（6.3%），神经系统疾病（6.0%），精神和行为障碍（5.6%），消化系统疾病（4.9%）；性别构成男性多于女性（Plt;0.05）；年龄构成以中老年较多，青少年儿童较少（Plt;0.05）；时刻分布规律高峰点为15点40分（Plt;0.05），季节分布以冬季较多（Plt;0.05）；患者转归以住院、留院观察为主，院前死亡人数占比例为3.8%。 结论 根据院前急救流行病学规律，可以合理配置急诊资源，增强应急救援能力，满足民众不断增加的医疗需求。【Abstract】 Objective To research on the epidemiological characteristics of the prehospital cases in Zigong emergency rescue center. Methods We retrospectively analyzed the database of prehospital cases in Zigong emergency rescue center in 2009, and reviewed the prehospital disease spectrum, gender composition, age structure, the circadian and seasonal distribution, and the outcomes of these cases. Results A total of 4 588 prehospital victims in Zigong emergency rescue center were enrolled. In the study, six leading diseases were injury, poisoning and certain other consequences due to external causes (45.6%), diseases of the circulatory system (15.0%), diseases of the respiratory system (6.3%), diseases of the nervous system (6.0%), mental and behavioral disorders (5.6%), and diseases of the digestive system (4.9%). Male patients were more than female patients (Plt;0.05). The proportion of the aged and the middle-aged was significantly larger than that of young population in the same districts (Plt;0.05), and the occurrence of prehospital care usually peaked at 15:40 (Plt;0.05). Prehospital care had a higher incidence in winter (Plt;0.05), and the outcome of prehospital cases was mainly in hospital and in observation ward. The proportion of deaths was 3.8%. Conclusion We can allocate emergency resources reasonably in prehospital care, and promote the ability of rescuing in order to meet people′s medical demands on the basis of the epidemiological study in our city.
Objective To explore the predictive value of Composite Congestion Score (CCS) in predicting adverse events within 180 days in patients with acute heart failure (AHF) in emergency intensive care unit (EICU). Methods The patients with AHF who were admitted to EICU of Zigong Fourth People’s Hospital between January 1, 2018 and December 31, 2020 were included consecutively. The patients were followed up for 180 days, and were divided into poor prognosis group and good prognosis group according to whether there were adverse events. Logistic regression equation was used to screen independent risk factors for predicting adverse events in patients with AHF within 180 days after leaving EICU. To compare the discrimination, calibration and clinical usefulness of independent risk factors at EICU discharge and the Acute Physiology and Chronic Health Assessment SystemⅡ (APACHEⅡ) score at EICU admission to predict the occurrence of adverse events of AHF. Results A total of 71 patients were included, including 32 patients with good prognosis and 39 patients with poor prognosis. Except for age, APACHEⅡscore at EICU admission and CCS score at EICU discharge (P<0.05), there was no significant difference in other indicators between the two groups (P>0.05). Logistic regression analysis showed that CCS score at EICU discharge [odds ratio (OR)=2.806, 95% confidence interval (CI) (1.428, 5.512), P=0.003], age [OR=1.086, 95%CI (1.017, 1.159), P=0.013] were independent risk factors for predicting death or returning to hospital within 180 days. Among them, the CCS score at EICU discharge combining with age had a positive improvement ability compared with the CCS score at EICU discharge, the age, and the APACHE Ⅱ score at EICU admission. The calibration curves of the four scoring methods for predicting adverse events within 180 days showed that the CCS score at EICU discharge had the highest calibration and the calibration of age was the lowest. The decision curve showed that the clinical usefulness of age, the CCS score at EICU discharge and the CCS score at EICU discharge combining with age was better than the APACHE Ⅱ score at EICU admission. Conclusions The CCS score of patients with AHF at EICU discharge is closely related to adverse events within 180 days. The CCS score is designed based on clinical variables, simple and practical. The combination of age and the CCS score at EICU discharge will further enhance its clinical application value.