口腔急诊科死亡病例分析

doi:10.19723/j.issn.1671-167X.2024.01.029

摘要/Abstract

摘要：

为了解口腔专科医院急诊科死亡病例的临床特点, 提高口腔专科医院的急诊救治水平, 我们收集了北京大学口腔医院急诊科2010年1月至2023年1月期间死亡病例的临床资料并进行回顾性分析。分析的数据包括死亡患者的性别、年龄、主诉、颌面部疾病诊断、全身基础疾病状况、抢救情况、死亡原因和死亡的季节分布。结果显示, 13年间共发生死亡病例8例(男性5例, 女性3例), 年龄为40~86岁, 中位年龄66岁。8例患者中, 5例主诉症状为口腔癌出血, 1例为口腔癌术后胸闷、呼吸困难, 1例为颌面部创伤后意识丧失, 1例为口腔糜烂无法进食。8例患者均合并有高血压、冠心病、糖尿病、肾功能衰竭、脑梗塞等基础疾病中的一项及以上, 其中2例患者表现为恶液质。5例患者的死亡原因为口腔癌破裂出血或外科手术伤口愈合不良、出血引发呼吸循环衰竭, 1例为尿毒症、高钾血症致循环衰竭, 1例为颌面部创伤后口底组织肿胀致窒息, 另一例为口腔癌术后急性心肌梗死致循环衰竭。6例患者在入院前已发生意识丧失、呼吸心跳停止, 2例患者在入院后医生治疗时发生意识丧失、呼吸心跳骤停, 所有患者均接受了心肺复苏及部分高级生命支持措施, 平均抢救时长46 min。因口腔急诊科患者死亡发生率较低, 医务人员参与急救的机会少, 应定期组织急救技能培训、演练和考核。急救设施(如心电监护仪、除颤仪、简易呼吸器、氧气供给系统、负压吸引系统、气管内插管与气管切开器械)应常备, 急救药品储备要充足, 并安排专人定期维护。死亡病例主要发生于伴有全身基础疾病的老年口腔癌出血患者。颌面外科医生对老年口腔癌术后的患者要加强宣教, 提高患者及家属的急诊意识。急诊医务人员要加强自身的急救技能训练, 接诊此类患者时也要加强急救意识。

关键词: 口腔急诊, 死亡, 急诊处理, 临床工作能力

Abstract:

In order to analyze the clinical characteristics of death cases in the oral emergency department of the stomatological hospital, and to improve the first aid technique before and in hospitals, we collected the clinical data of death cases in the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2010 to January 2023 for retrospective analysis. General cha-racteristics, such as the patients' gender, age, chief complaint, maxillofacial diseases, systemic underlying diseases, rescue situation, cause of death and seasonal distribution of death were summarized. The results showed that a total of 8 death cases (5 males and 3 females) occurred during the 13-year period, ranging in age from 40 to 86 years, with a median age of 66 years. Among the 8 patients, 5 reported bleeding from oral cancer, 1 reported chest tightness and dyspnea after oral cancer surgery, 1 reported loss of consciousness after maxillofacial trauma, and 1 reported oral erosion and aphagia. All the 8 patients had one or more underlying diseases, such as hypertension, coronary heart disease, diabetes, renal failure, and cerebral infarction, etc. and 2 of them showed dyscrasia. Among them, the cause of death in 5 cases was respiratory and circulatory failure caused by oral cancer rupture and hemorrhage or poor surgical wound healing and hemorrhage; 1 case was uremia and hyperkalemia leading to circulatory failure; 1 case was asphyxia caused by swelling of oral floor tissue after maxillofacial trauma; and the other case was acute myocardial infarction caused circulatory failure after oral cancer surgery. According to the vital state at the time of treatment, 6 patients had loss of consciousness, respiratory and cardiac arrest before hospital, and 2 patients suffered from loss of consciousness, respiratory and cardiac arrest during treatment. All the patients received cardiopulmonary resuscitation and some advanced life support measures, and the average rescue time was 46 min. Due to the low incidence of death in the oral emergency department, medical personel have little experience in first aid. First aid training and drills and assessment should be organized regularly. First aid facilities should be always available and regularly maintained by special personnel, such as electrocardiogram (ECG) monitor, defibrillator, simple breathing apparatus, oxygen supply system, negative pressure suction system, endotracheal intubation and tracheotomy equipment. The death cases mainly occurred in the elderly patients with oral cancer bleeding and systemic underlying diseases. Education of emergency awareness for the elderly patients with oral cancer after surgery should be enhanced. Medical staff should strengthen first aid awareness and skills.

Key words: Oral emergency, Death, Emergency treatment, Clinical competence

中图分类号:

R459.7

徐训敏,邵校,姬爱平. 口腔急诊科死亡病例分析[J]. 北京大学学报（医学版）, 2024, 56(1): 185-189.

Xunmin XU,Xiao SHAO,Aiping JI. Analysis of death cases in the oral emergency department[J]. Journal of Peking University (Health Sciences), 2024, 56(1): 185-189.

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