新生儿重症监护病房自动出院：一所大学医院的10年经验
Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital.
作者信息
Al-Turkistani Hatim K
机构信息
Department of Pediatrics, King Fahd Hospital of the University, Alkhobar, Kingdom of Saudi Arabia.
出版信息
J Family Community Med. 2013 May;20(2):113-5. doi: 10.4103/2230-8229.114774.
BACKGROUND
Discharging patients against medical advice is a problem of every age-group. However, because of their physiological vulnerability, the risk for the neonatal population is greater when discharged against medical advice (DAMA). This article is a study of the prevalence of the problem, the possible causes and/or risk factors.
MATERIALS AND METHODS
A retrospective review of 10 years of medical records of neonates discharged against medical advice from a Neonatal Intensive Care Unit (NICU) at a university hospital.
RESULTS
The overall prevalence of DAMA was 1.6%. Most of the 51 infants who were taken out of hospital against medical advice (AMA) were term (72.5%) with a mean gestational age of 37.78 ± 2.5 weeks, of normal birth weight, with a mean of 2736 ± 661 g, Saudis (96%), those delivered vaginally (69%), and those that were provisionally diagnosed with transient tachypnea of newborn (TTN) and/or query sepsis (49%). There was no difference between males and females (M/F = 1.2). There was an association between DAMA and the timing of DAMA (27.5% of DAMA at weekends and 67% of DAMA from May to October).
CONCLUSION
DAMA of neonates is particularly critical. The causes and risk factors are many and difficult to predict. In addition to several other factors, its prevalence is influenced negatively by some socio-cultural beliefs.
背景
违背医嘱让患者出院是各个年龄组都存在的问题。然而，由于新生儿生理上较为脆弱，违背医嘱出院（DAMA）时新生儿面临的风险更大。本文对该问题的发生率、可能的原因和/或风险因素进行了研究。
材料与方法
对一家大学医院新生儿重症监护病房（NICU）10年间违背医嘱出院的新生儿病历进行回顾性研究。
结果
违背医嘱出院的总体发生率为1.6%。51名违背医嘱出院（AMA）的婴儿中，大多数为足月儿（72.5%），平均胎龄37.78±2.5周，出生体重正常，平均为2736±661克，沙特人（96%），经阴道分娩（69%），初步诊断为新生儿短暂性呼吸急促（TTN）和/或疑似败血症（49%）。男女之间无差异（男/女=1.2）。违背医嘱出院与出院时间有关（27.5%的违背医嘱出院发生在周末，67%的违背医嘱出院发生在5月至10月）。
结论
新生儿违背医嘱出院情况尤其严重。原因和风险因素众多且难以预测。除了其他一些因素外，其发生率还受到一些社会文化观念的负面影响。
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