2023 年第 2 期 第 18 卷

急诊患者院内转运期间病情恶化的危险因素分析

Risk factors of deterioration of emergency patients during in-hospital transfer

作者：祁琪1张文玲1李玉芳2

英文作者：Qi Qi1 Zhang Wenling1 Li Yufang2

单位：1新疆医科大学第一附属医院急救创伤中心，乌鲁木齐830054；2新疆医科大学第一附属医院肾脏疾病中心血液透析一科，乌鲁木齐830054

英文单位：1Emergency Trauma Center the First Affiliated Hospital of Xinjiang Medical University Urumqi 830054 China; 2the First Department of Hemodialysis Kidney Disease Center the First Affiliated Hospital of Xinjiang Medical University Urumqi 830054 China

关键词：急诊；院内转运；病情恶化；危险因素

英文关键词：Emergency;In-hospitaltransfer;Deterioration;Riskfactors

• 摘要：

• 目的 探究急诊患者院内转运期间病情恶化的危险因素。方法 回顾性选取2018年1月至2019年12月新疆医科大学第一附属医院急诊科收治的328例患者作为研究对象。所有患者在急诊科完成初步处理后转至专科接受进一步检查或治疗。统计患者院内转运期间意外事件和病情恶化发生情况，以患者有无病情恶化将其分为恶化组和未恶化组，比较2组患者临床资料。采用多因素Logistic回归模型分析急诊患者院内转运期间病情恶化的危险因素。结果 328例患者中49例发生意外事件，发生率为14.9%。院内转运期间病情恶化78例（恶化组）、250例未发生病情恶化（未恶化组）。恶化组患者意外事件发生率明显高于未恶化组［35.9%（28/78）比8.4%（21/250）］，差异有统计学意义（P＜0.001）。2组年龄＞60岁比例、疾病类型、机械通气及转入重症监护病房（ICU）患者比例比较差异均有统计学意义（均P＜0.001）。多因素Logistic回归分析结果显示，年龄＞60岁（比值比=2.804,95%置信区间：2.222~7.453）、呼吸系统疾病（比值比=1.904,95%置信区间：1.540~6.282）、机械通气（比值比=3.395,95%置信区间：1.895~12.024）、转入ICU（比值比=11.262,95%置信区间：4.336~24.157）、意外事件发生（比值比=8.491,95%置信区间：3.097~19.185）均为急诊患者院内转运期间病情恶化的独立危险因素（均P＜0.05）。结论 年龄＞60岁、呼吸系统疾病、机械通气、转入ICU及意外事件发生为急诊患者院内转运期间病情恶化的独立危险因素。

• Objective To explore the risk factors of deterioration of emergency patients during in-hospital transfer. Methods  Totally 328 patients were retrospectively enrolled from Department of Emergency, the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2019. All patients were transferred to the specialist departments for further examination or treatment after completing the initial treatment in Department of Emergency. The incidences of accidents and the deterioration of the patients during in-hospital transfer were counted. Patients were divided into deterioration group and non-deterioration group, and clinical data were compared between the two groups. Multivariate Logistic regression model was used to analyze risk factors of deterioration in emergency patients during in-hospital transfer. Results  There were 49 accidents occurred in the 328 patients, with a rate of 14.9%. Of all the patients, 78 cases had deterioration (deterioration group) and 250 cases had no deterioration (non-deterioration group) during in-hospital transfer. The rate of accident in deterioration group was higher than that in non-deterioration group［35.9%（28/78） vs 8.4%（21/250）］(P<0.001). There were significant differences in rates of age >60 years, disease classification, mechanical ventilation and transferring to intensive care unit (ICU) between the two groups (all P<0.001). Multivariate Logistic regression analysis showed that age >60 years (odds ratio=2.804, 95% confidence interval: 2.222-7.453), respiratory diseases (odds ratio=1.904, 95% confidence interval: 1.540-6.282), mechanical ventilation (odds ratio=3.395, 95% confidence interval: 1.895-12.024), transferring to ICU (odds ratio=11.262, 95% confidence interval: 4.336-24.157) and accidents (odds ratio=8.491, 95% confidence interval: 3.097-19.185) were risk factors for the deterioration in emergency patients during in-hospital transfer (all P<0.05). Conclusion  Age >60 years, respiratory diseases, mechanical ventilation, transferring to ICU and accidents were independent risk factors of deterioration in emergency patients during in-hospital transfer.