Bierens J J, van der Velde E A, van Berkel M, van Zanten J J
Department of Internal Medicine, University Hospital Leiden, The Netherlands.
Ann Emerg Med. 1990 Dec;19(12):1390-5. doi: 10.1016/s0196-0644(05)82604-6.
To analyze prognostic indicators and the outcome of resuscitation in submersion victims (drowning and near drowning).
Retrospective study.
Intensive and Respiratory Care Unit. Between January 1, 1979, and December 31, 1985, 87 submersion victims were admitted. The files of 83 victims were available for statistical analysis. There were 66 male victims and 17 female victims; the average age was 31.4 +/- 25.8 years. There were ten salt water and 73 fresh water submersions.
Predictors for better survival potentials were a young age, submersion of less than ten minutes, no signs of aspiration, and a central body temperature of less than 35 C at admission. We did not detect factors that accelerated a decrease in core body temperature at admission and assume that lethal hypoxia had preceded protective hypothermia in our submersion victims. The Orlowski score had a predictive value but at the same time we found nonindependent indicators in this score. Neurologic outcome in our patients, who were not treated according to a brain protection protocol, was not worse than the outcome published by authors who have used such a protocol. Thirty-three percent of the victims with a cardioventilatory arrest (15) and all victims with a ventilatory arrest (11) survived resuscitation and were discharged. Five nonarrest victims died due to late complications.
This study shows that no indicator at the rescue site and in the hospital is absolutely reliable with respect to death or survival.
分析溺水者（溺水和近乎溺水）复苏的预后指标及结果。
回顾性研究。
重症监护和呼吸监护病房。1979年1月1日至1985年12月31日期间，收治了87名溺水者。83名受害者的病历可供统计分析。男性受害者66名，女性受害者17名；平均年龄为31.4±25.8岁。其中10例为海水溺水，73例为淡水溺水。
生存可能性较大的预测因素为年龄较小、溺水时间少于10分钟、无吸入迹象以及入院时中心体温低于35℃。我们未发现入院时加速核心体温下降的因素，并推测在我们的溺水受害者中，致命性缺氧先于保护性低温出现。奥洛夫斯基评分具有预测价值，但同时我们在该评分中发现了非独立指标。我们的患者未按照脑保护方案进行治疗，其神经学结果并不比使用该方案的作者所发表的结果差。33%的心肺骤停受害者（15例）和所有呼吸骤停受害者（11例）复苏成功并出院。5名未骤停的受害者因晚期并发症死亡。
本研究表明，在救援现场和医院，关于死亡或生存，没有任何指标是绝对可靠的。
