Sacks J J, Stroup D F, Will M L, Harris E L, Israel E
Division of Field Services, Centers for Disease Control, Atlanta, GA 30333.
JAMA. 1988 Feb 5;259(5):689-95.
Review of 2219 admissions to an intensive care unit at a large urban hospital from 1983 to 1985 revealed an epidemic of cardiac arrests during the evening shift from January 1984 to March 1985. Of the 88 evening-shift cardiac arrests during this time, one specific nurse (Nurse 14) was the care giver for 57 (65%). Eight of ten epidemic-period patients who experienced shift-specific circadian recurrences of cardiac arrests were patients of Nurse 14. No therapeutic intervention and no other health care provider was as strongly associated with evening-shift cardiac arrests as was Nurse 14. Multiple logistic regression analysis demonstrated that when risk of cardiac arrest was adjusted for age, sex, severity of illness, and postoperative status, patients of Nurse 14 were 47.5 times more likely to experience arrest than were other nurses' patients. An expert determined that, compared with other nurses, the cardiac arrests among Nurse 14's patients were more likely to be consistent with unexplained hyperkalemia, to be unexpected in timing, and to be inconsistent with the clinical course. The epidemic ceased when Nurse 14 left employment at the intensive care unit in March 1985. Epidemiologic surveillance of adverse outcomes in health care settings is recommended.
对一家大型城市医院1983年至1985年期间重症监护病房的2219例入院病例进行回顾后发现，1984年1月至1985年3月的晚班期间发生了心脏骤停疫情。在此期间的88例晚班心脏骤停病例中，有一名特定护士（护士14）护理了57例（65%）。在经历了特定班次昼夜节律性心脏骤停复发的10例疫情期间患者中，有8例是护士14的患者。与晚班心脏骤停关联最紧密的不是任何治疗干预措施，也不是其他医护人员，而是护士14。多元逻辑回归分析表明，在对心脏骤停风险进行年龄、性别、疾病严重程度和术后状态调整后，护士14护理的患者发生心脏骤停的可能性是其他护士护理患者的47.5倍。一名专家判定，与其他护士相比，护士14护理的患者发生的心脏骤停更有可能与不明原因的高钾血症相符，在时间上出人意料，且与临床病程不符。1985年3月护士14离开重症监护病房后，疫情停止。建议对医疗机构中的不良后果进行流行病学监测。
