社区急诊科中心静脉置管术的发生率增加。
Increased rate of central venous catheterization procedures in community EDs.
机构信息
Duke Clinical Research Institute, Duke University School of Medicine, PO Box 17969, Durham, NC 27715, USA.
出版信息
Am J Emerg Med. 2010 Feb;28(2):208-12. doi: 10.1016/j.ajem.2008.10.016.
OBJECTIVE
Central venous catheterization (CVC) is integral to the emergency department (ED) treatment of critically ill patients, such as those receiving early goal-directed therapy for severe sepsis. No previous studies have described the overall use of CVC in community EDs. The objective of this study was to estimate the overall frequency and temporal trends in CVC use in a sample of patients visiting community EDs.
METHODS
This was a retrospective observational study of 2.97 million patient visits at 28 community EDs (range of annual visits, 10 837-110 136) from January 2004 to February 2008. Data were obtained from a community-based research consortium. Central venous catheterization procedures were aggregated at the hospital level for each study year. Trends in CVC use were evaluated using linear regression.
RESULTS
Three thousand four hundred eighty-nine patient visits (0.12% of all ED patient visits) had a CVC procedure performed in the ED. The overall rate of CVC procedures per 1000 ED patient visits increased from 0.87 (95% confidence interval [CI(95%)], 0.80-0.95) in 2004 to 1.62 (CI(95%), 1.38-1.91) procedures in 2008 (P value for trend = .003). There was wide variability in the frequency of CVC procedures performed among EDs, ranging from a low of 0.27 (CI(95%), 0.18-0.42) to a high of 7.58 (CI(95%), 6.27-9.17) procedures per 1000 ED visits. The CVC procedure rates were lower in the 8 rural EDs (0.99 CVCs per 1000 ED patient visits [CI(95%), 0.91-1.07] compared with the 20 urban EDs (1.22 CVCs [CI(95%), 1.18-1.27]; P < .001). An increasing rate of CVC procedures during the study period was observed in urban EDs (0.84-1.94 CVCs per 1000 ED patient visits; P value for trend = .005) but not in rural EDs (1.1-0.93; P value for trend = .41) during the study period.
CONCLUSION
The overall rate of CVC increased from 2004 to 2008. However, there was a wide variation among Eds, and the CVC rate was lower in rural compared with urban EDs. The increase in CVC use in urban EDs may reflect more intensive therapy in the management of ED patients with acute illness or injury. Future efforts are needed to optimize best practices for the use of CVC in community ED practices and to characterize factors responsible for urban rural differences in the rate of CVC procedures.
目的
中心静脉置管（CVC）是急诊科（ED）治疗危重病患者的重要手段，例如那些正在接受严重脓毒症早期目标导向治疗的患者。之前没有研究描述过社区 ED 中 CVC 的总体使用情况。本研究的目的是评估在社区 ED 就诊的患者样本中 CVC 使用的总体频率和时间趋势。
方法
这是一项对 2004 年 1 月至 2008 年 2 月期间 28 个社区 ED 297 万例患者就诊的回顾性观察性研究（每年就诊量范围为 10837-110136 例）。数据来自一个基于社区的研究联盟。每个研究年度在医院层面汇总 CVC 操作。使用线性回归评估 CVC 使用趋势。
结果
3489 例（所有 ED 患者就诊的 0.12%）在 ED 进行了 CVC 操作。每 1000 例 ED 患者就诊的 CVC 操作率从 2004 年的 0.87（95%置信区间[CI（95%）]，0.80-0.95）增加到 2008 年的 1.62（CI（95%），1.38-1.91）（趋势检验 P 值=.003）。ED 之间 CVC 操作的频率差异很大，范围从低的 0.27（95%CI（95%），0.18-0.42）到高的 7.58（95%CI（95%），6.27-9.17）每 1000 例 ED 就诊 1 例。与 20 家城市 ED 相比（1.22 例 CVC[CI（95%），1.18-1.27]），农村 8 家 ED 的 CVC 操作率较低（每 1000 例 ED 患者就诊 0.99 例 CVC[CI（95%），0.91-1.07]）（P<0.001）。在研究期间，城市 ED 中 CVC 操作的比率呈上升趋势（每 1000 例 ED 患者就诊的 0.84-1.94 例 CVC；趋势检验 P 值=.005），但农村 ED 中无此趋势（1.1-0.93；趋势检验 P 值=.41）。
结论
从 2004 年到 2008 年，CVC 的总体使用率有所增加。然而，ED 之间存在很大差异，农村 ED 的 CVC 使用率低于城市 ED。城市 ED 中 CVC 使用量的增加可能反映了对急性疾病或损伤的 ED 患者的治疗更加积极。未来需要努力优化社区 ED 实践中 CVC 使用的最佳实践，并描述导致 CVC 操作率城乡差异的因素。
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