非工作时间行紧急气管插管与住院患者死亡率的增加无关：一项回顾性队列研究。

Emergency tracheal intubation during off-hours is not associated with increased mortality in hospitalized patients: a retrospective cohort study.

机构信息

Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China.

Department of Clinical Medicine, Fujian Health College, 366th GuanKou, Fuzhou, 350101, Fujian, China.

出版信息

BMC Anesthesiol. 2020 Oct 21;20(1):265. doi: 10.1186/s12871-020-01188-3.

DOI:10.1186/s12871-020-01188-3

PMID:33087063

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7576761/

Abstract

BACKGROUND

The prognosis of hospitalized patients after emergent endotracheal intubation (ETI) remains poor. Our aim was to evaluate the 30-d hospitalization mortality of subjects undergoing ETI during daytime or off-hours and to analyze the possible risk factors affecting mortality.

METHODS

A single-center retrospective study was performed at a university teaching facility from January 2015 to December 2018. All adult inpatients who received ETI in the general ward were included. Information on patient demographics, vital signs, ICU (Intensive care unit) admission, intubation time (daytime or off-hours), the department in which ETI was performed (surgical ward or medical ward), intubation reasons, and 30-d hospitalization mortality after ETI were obtained from a database.

RESULTS

Over a four-year period, 558 subjects were analyzed. There were more male than female in both groups (115 [70.1%] vs 275 [69.8%]; P = 0.939). A total of 394 (70.6%) patients received ETI during off-hours. The patients who received ETI during the daytime were older than those who received ETI during off-hours (64.95 ± 17.54 vs 61.55 ± 17.49; P = 0.037). The BMI of patients who received ETI during the daytime was also higher than that of patients who received ETI during off-hours (23.08 ± 3.38 vs 21.97 ± 3.25; P < 0.001). The 30-d mortality after ETI was 66.8% (373), which included 68.0% (268) during off-hours and 64.0% (105) during the daytime (P = 0.361). Multivariate Cox regression analysis found that the significant factors for the risk of death within 30 days included ICU admission (HR 0.312, 0.176-0.554) and the department in which ETI was performed (HR 0.401, 0.247-0.653).

CONCLUSIONS

The 30-d hospitalization mortality after ETI was 66.8%, and off-hours presentation was not significantly associated with mortality. ICU admission and ETI performed in the surgical ward were significant factors for decreasing the risk of death within 30 days.

TRIAL REGISTRATION

This trial was retrospectively registered with the registration number of ChiCTR2000038549 .

摘要

背景

急诊气管插管（ETI）后住院患者的预后仍然很差。我们的目的是评估日间或非工作时间接受 ETI 的患者的 30 天住院死亡率，并分析影响死亡率的可能危险因素。

方法

这是一项在大学教学机构进行的单中心回顾性研究，时间为 2015 年 1 月至 2018 年 12 月。所有在普通病房接受 ETI 的成年住院患者均纳入研究。从数据库中获取患者人口统计学、生命体征、入住 ICU、插管时间（日间或非工作时间）、进行 ETI 的科室（外科病房或内科病房）、插管原因以及 ETI 后 30 天住院死亡率等信息。

结果

在四年期间，共分析了 558 例患者。日间组和非工作时间组中男性均多于女性（115 [70.1%] 比 275 [69.8%]；P = 0.939）。共有 394 例（70.6%）患者在非工作时间接受 ETI。日间组的患者比非工作时间组的患者年龄更大（64.95 ± 17.54 比 61.55 ± 17.49；P = 0.037）。日间组患者的 BMI 也高于非工作时间组（23.08 ± 3.38 比 21.97 ± 3.25；P < 0.001）。ETI 后 30 天死亡率为 66.8%（373 例），其中非工作时间组为 68.0%（268 例），日间组为 64.0%（105 例）（P = 0.361）。多变量 Cox 回归分析发现，30 天内死亡的危险因素包括入住 ICU（HR 0.312，0.176-0.554）和 ETI 进行的科室（HR 0.401，0.247-0.653）。