溺水分类：严重病例临床表现和预后的再评估。

Drowning Classification: A Reappraisal of Clinical Presentation and Prognosis for Severe Cases.

机构信息

Emergency Department, Timone University Hospital, Aix-Marseille University, Marseille, France.

出版信息

Chest. 2020 Aug;158(2):596-602. doi: 10.1016/j.chest.2020.01.035. Epub 2020 Feb 14.

DOI:10.1016/j.chest.2020.01.035

PMID:32067943

Abstract

BACKGROUND

Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable efforts have been made to improve prevention and care, it seemed appropriate to reassess the prognosis and clinical presentation of drowning patients more than 20 years after this first publication. The aim of this study is to provide a reappraisal of patients who need advanced health care and a precise description of their respective neurologic, respiratory, and hemodynamic profiles.

METHODS

This retrospective study was conducted over four consecutive summer periods between 2014 and 2017 in ICUs located in France, French Polynesia, and the French Antilles. Patients were classified according to the drowning classification system proposed by Szpilman.

RESULTS

During the study period, 312 drowning patients were admitted with severe clinical presentation (grades 2-6). All patients benefited from rapid extraction from the water (< 10 min for all) and specialized care (emergency medical services), starting from the prehospital period. Although the global hospital mortality was similar to that previously reported (18.5%), great differences existed among the severity grades. Respective grade mortalities were low for grades 2 through 5 (grade 2, 0%; grade 3, 3%; grade 4, 0%; grade 5, 2%), and the mortality for grade 6 remained similar to that previously reported (54%). These results confirmed that the occurrence of cardiac arrest after drowning is still bad prognosis. Conversely, for other grades, this study strengthens the importance of specialized intervention to interrupt the drowning process.

CONCLUSIONS

On the basis of these results, drowning-related cardiac arrest is still the prognosis cornerstone. For other victims, the prognosis was better than previously expected, which strengthens the importance of specialized intervention to interrupt the drowning process.

摘要

背景

溺水仍然是全世界导致意外死亡的主要原因。1997 年，Szpilman 提出了一种溺水分类法，成为了参考标准。鉴于为改善预防和护理措施做出了巨大努力，在该分类法首次发表 20 多年后，重新评估溺水患者的预后和临床表现似乎是合适的。本研究旨在评估需要高级医疗保健的患者，并详细描述他们各自的神经、呼吸和血液动力学特征。

方法

这是一项回顾性研究，于 2014 年至 2017 年在法国、法属波利尼西亚和法属安的列斯的重症监护病房连续进行了四个夏季。患者根据 Szpilman 提出的溺水分类系统进行分类。

结果

在研究期间，312 名溺水患者因严重的临床表现（2-6 级）被收治。所有患者均受益于从水中迅速被救出（所有患者均在 10 分钟内）和专科护理（急救医疗服务），从院前阶段开始。尽管全球住院死亡率与之前报道的相似（18.5%），但各严重程度等级之间存在很大差异。相应的等级死亡率对于 2-5 级较低（2 级为 0%；3 级为 3%；4 级为 0%；5 级为 2%），而 6 级的死亡率与之前报道的相似（54%）。这些结果证实，溺水后发生心脏骤停仍然预后不良。相反，对于其他等级，本研究加强了专门干预以中断溺水过程的重要性。