Fu Ken-Hui, Chen Yin-Ru, Fan Ju-Shin, Chen Yen-Chia, Huang Hsien-Hao, How Chorng-Kuang, Yen David Hung-Tsang, Chen Shih-Ann, Huang Mu-Shun
Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medicine, Yee-Zen Hospital, Taoyuan, Taiwan, ROC.
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2017 Apr;80(4):233-244. doi: 10.1016/j.jcma.2016.09.008. Epub 2016 Dec 28.
We investigated an intensive care model for acute critically cardiovascular emergency patients in the emergency department (ED) as compared with those in the coronary care unit (CCU) after ED visits.
We performed a retrospective cohort analysis of patients with acute cardiovascular emergency admitted to the intensive care unit in the ED (EICU) or CCU from January 1, 2010 to March 31, 2011 in an university-affiliated medical center. All clinical characteristics or predictors possibly related to in-hospital mortality were documented, completed, and measured via electronic medical records review. The clinical independent variables with p < 0.1 in univariate analysis were further analyzed by using multiple logistic regression. Survival analysis of the predictors for hospital mortality was assessed by Kaplan-Meier survival curves.
A total of 964 patients were recruited in this study. Of all patients, 328 were enrolled in the EICU group, whereas 636 were enrolled in the CCU group. Multiple regression analysis of both EICU and CCU mortality demonstrated that Acute Physiology and Chronic Health Evaluation II scores were common predictors of mortality in both groups of patients. Based on these scores, Kaplan-Meier survival curves showed no statistically significant differences of cumulative survival rates in both the 7-day and in-hospital survival between both groups.
Our study demonstrated a feasible and qualified model of intensive care delivery accomplished by collaboration of emergency physicians and cardiologists for acute critically ill cardiovascular emergency patients after initial ED management. Our results suggest that an expanded multicenter study should be conducted to further test and confirm this intriguing model.
我们研究了急诊科（ED）针对急性重症心血管急症患者的重症监护模式，并与急诊就诊后入住冠心病监护病房（CCU）的患者进行了比较。
我们对2010年1月1日至2011年3月31日在一所大学附属医院医疗中心急诊科（EICU）或CCU接受重症监护的急性心血管急症患者进行了回顾性队列分析。通过电子病历回顾记录、完善并测量所有可能与住院死亡率相关的临床特征或预测因素。对单因素分析中p<0.1的临床自变量，进一步采用多因素逻辑回归进行分析。通过Kaplan-Meier生存曲线评估医院死亡率预测因素的生存分析。
本研究共纳入964例患者。所有患者中，328例纳入EICU组，636例纳入CCU组。对EICU和CCU死亡率的多因素回归分析表明，急性生理与慢性健康状况评估II（APACHE II）评分是两组患者死亡率的常见预测因素。基于这些评分，Kaplan-Meier生存曲线显示两组在7天和住院生存率方面的累积生存率无统计学显著差异。
我们的研究表明，在急诊科初步处理后，由急诊医师和心脏病专家合作完成的针对急性重症心血管急症患者的重症监护模式是可行且合格的。我们的结果表明，应开展一项扩大的多中心研究，以进一步测试和证实这一有趣的模式。
