Igarashi Yutaka, Yokobori Shoji, Yoshino Yudai, Masuno Tomohiko, Miyauchi Masato, Yokota Hiroyuki
Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Am J Emerg Med. 2017 Oct;35(10):1396-1399. doi: 10.1016/j.ajem.2017.04.016. Epub 2017 Apr 10.
In Japan, the number of patients with foreign body airway obstruction by food is rapidly increasing with the increase in the population of the elderly and a leading cause of unexpected death. This study aimed to determine the factors that influence prognosis of these patients.
This is a retrospective single institutional study. A total of 155 patients were included. We collected the variables from the medical records and analyzed them to determine the factors associated with patient outcome. Patient outcomes were evaluated using cerebral performance categories (CPCs) when patients were discharged or transferred to other hospitals. A favorable outcome was defined as CPC 1 or 2, and an unfavorable outcome was defined as CPC 3, 4, or 5.
A higher proportion of patients with favorable outcomes than unfavorable outcomes had a witness present at the accident scene (68.8% vs. 44.7%, P=0.0154). Patients whose foreign body were removed by a bystander at the accident scene had a significantly high rate of favorable outcome than those whose foreign body were removed by emergency medical technicians or emergency physician at the scene (73.7% vs. 31.8%, P<0.0075) and at the hospital after transfer (73.7% vs. 9.6%, P<0.0001).
The presence of a witness to the aspiration and removal of the airway obstruction of patients by bystanders at the accident scene improves outcomes in patients with foreign body airway obstruction. When airway obstruction occurs, bystanders should remove foreign bodies immediately.
在日本，因食物导致气道异物梗阻的患者数量随着老年人口的增加而迅速上升，这是意外死亡的一个主要原因。本研究旨在确定影响这些患者预后的因素。
这是一项回顾性单机构研究。共纳入155例患者。我们从病历中收集变量并进行分析，以确定与患者预后相关的因素。当患者出院或转至其他医院时，使用脑功能分类（CPC）评估患者预后。良好预后定义为CPC 1或2，不良预后定义为CPC 3、4或5。
与不良预后患者相比，良好预后患者中事故现场有目击者的比例更高（68.8%对44.7%，P = 0.0154）。事故现场异物被旁观者取出的患者，其良好预后率显著高于异物被现场急救医疗技术人员或急救医生取出的患者（73.7%对31.8%，P < 0.0075）以及转至医院后异物被取出的患者（73.7%对9.6%，P < 0.0001）。
事故现场有目击者看到旁观者对患者气道梗阻进行抽吸和取出，可改善气道异物梗阻患者的预后。当发生气道梗阻时，旁观者应立即取出异物。
