CLINICAL ANTECEDENTS TO IN-HOSPITAL CARDIOPULMONARY ARREST
CLINICAL ANTECEDENTS TO IN-HOSPITAL CARDIOPULMONARY ARREST
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DOI：
10.1378/chest.98.6.1388
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发表时间：
1990-12-01
期刊：
影响因子：
9.6
通讯作者：
SPRUNG, CL
中科院分区：
文献类型：
--
作者：
SCHEIN, RMH;HAZDAY, N;SPRUNG, CL
虽然院内心肺骤停的结果已被广泛研究，但临床上发生心肺骤停的因素还不是很清楚。我们研究了一组连续出现心肺骤停的普通医院病房患者。使用前瞻性确定的潜在病理生理学定义、潜在疾病的严重性、患者主诉和临床观察来确定共同的临床特征。64名患者被捕161。+-。入院后26小时。停搏前病理生理改变：呼吸系统改变24例(38%)，代谢改变7例(11%)，心脏改变6例(9%)，神经系统改变4例(6%)，多发性改变17例(27%)，未分类6例(9%)。有多种障碍的患者主要有呼吸系统(39%)和代谢(44%)障碍。54名患者(84%)在被捕后8小时内记录了临床恶化或新的症状。70%的患者在此期间观察到呼吸或精神功能恶化。在被捕前进行的常规实验室检查显示没有一致的异常，但生命体征显示平均呼吸频率为29。+-。每分钟呼吸1次。患者潜在疾病的预后被分类为最终致命的26例(41%)，非致命的23例(36%)，以及快速致命的15例(23%)。5名患者(8%)存活至出院。在普通医院病房服务中出现骤停的患者在被捕前主要是呼吸和代谢紊乱。他们的潜在疾病一般不会很快致命。心跳骤停之前，往往会出现呼吸或精神功能的临床恶化。这些特点和与逮捕相关的高死亡率表明，预测和防止逮捕的努力可能被证明是有益的。
While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrests. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161 .+-. 26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29 .+-. 1 breaths per minute. The prognoses of patients'' underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial.