住院患者入院时呼吸困难的患病率。
Prevalence of Dyspnea Among Hospitalized Patients at the Time of Admission.
机构信息
Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
出版信息
J Pain Symptom Manage. 2018 Jul;56(1):15-22.e2. doi: 10.1016/j.jpainsymman.2018.02.013. Epub 2018 Feb 22.
CONTEXT
Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients.
OBJECTIVES
There is no large-scale study of the prevalence and intensity of patient-reported dyspnea at the time of admission to the hospital.
METHODS
Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's 1) current level of dyspnea on a 0-10 scale with 10 anchored at "unbearable," 2) worst dyspnea in the past 24 hours before arrival at the hospital on the same 0-10 scale, and 3) activities that were associated with dyspnea before admission. The prevalence of dyspnea was identified, and tests of difference were performed across patient characteristics.
RESULTS
We analyzed 67,362 patients, 12% of whom were obstetric patients. Fifty percent of patients were admitted to a medical-surgical unit after treatment in the emergency department. Among all noncritically ill inpatients, 16% of patients experienced dyspnea in the 24 hours before the admission. Twenty-three percent of patients admitted through the emergency department reported any dyspnea in the past 24 hours. Eleven percent experienced some current dyspnea when interviewed within 12 hours of admission with 4% of patients experiencing dyspnea that was rated 4 or greater. Dyspnea of 4 or more was present in 43% of patients admitted with respiratory diagnoses and 25% of patients with cardiovascular diagnoses. After multivariable adjustment for severity of illness and patient comorbidities, patients admitted on the weekend or during the overnight nursing shift were more likely to report dyspnea on admission.
CONCLUSION
Dyspnea is a common symptom among all hospitalized patients. Routine documentation of dyspnea is feasible in a large tertiary care center.
背景
呼吸困难是住院患者的一种不适和痛苦的感觉。
目的
目前还没有大规模的研究调查住院患者入院时报告的呼吸困难的患病率和严重程度。
方法
2014 年 3 月至 2016 年 9 月，我们在马萨诸塞州波士顿的一家单一的三级保健中心对所有连续住院的患者进行了一项前瞻性队列研究。在入住内科-外科和产科病房的头 12 小时内，我们机构的护士常规收集患者的以下信息：1）目前的呼吸困难程度，使用 0-10 分制，10 分表示“无法忍受”；2）入院前 24 小时内最严重的呼吸困难程度，同样使用 0-10 分制；3）入院前与呼吸困难相关的活动。确定呼吸困难的患病率，并根据患者特征进行差异检验。
结果
我们分析了 67362 名患者，其中 12%为产科患者。50%的患者在急诊科治疗后入住内科-外科病房。在所有非危重症住院患者中，16%的患者在入院前 24 小时内有呼吸困难。23%的急诊科入院患者报告过去 24 小时内有任何呼吸困难。11%的患者在入院 12 小时内接受采访时出现了一些当前的呼吸困难，其中 4%的患者的呼吸困难评分为 4 或更高。4 分或更高的呼吸困难出现在 43%的呼吸系统诊断患者和 25%的心血管系统诊断患者中。对疾病严重程度和患者合并症进行多变量调整后，周末或夜间护理班次入院的患者更有可能在入院时报告呼吸困难。
结论
呼吸困难是所有住院患者的常见症状。在大型三级保健中心常规记录呼吸困难是可行的。
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