摘要
目的:探讨平车休息疗法对高血压亚急症患者的治疗效果。方法:回顾性分析2021年9月—2022年9月期间我院急诊内科就诊的115例高血压亚急症患者,根据是否使用平车休息疗法治疗分为平车组62例和非平车组53例,对比分析两组患者血压下降幅度、急诊就诊用时、进入急诊抢救室比率及医疗费用等指标差异,采用多元logistic回归分析患者转入抢救室治疗的危险因素,绘制ROC曲线,评估独立危险因素对转入抢救室治疗的预测价值。结果:两组患者年龄、男女比例、既往有无高血压病、症状和预检时收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)之间进行比较,差异无统计学意义(P>0.05)。预检分诊2 h后平车组患者血压(SBP、DBP和MAP)下降更明显,急诊就诊用时缩短,入抢救室率更低,治疗费用更少,与非平车组比较差异均有统计学意义(P<0.05)。多因素logistic回归分析提示是否实施平车休息疗法治疗和预检MAP为独立危险因素(P<0.05)。预检MAP预测入抢救室效能ROC曲线下面积(AUC)为0.869,截点值MAP为141 mmHg(1 mmHg=0.133 kPa)时,预测转入抢救室特异度为78%,灵敏度为80%。结论:对于高血压亚急症患者,预检分诊后实施平车休息疗法,就诊全程由家属推送,配合积极口服药物治疗,病情可以得到有效的缓解,值得临床推广。对于预检MAP≥141 mmHg,建议直接入抢救室采取静脉降压。
Objective:To investigate the relief effect of flat car on emergency hypertensive urgency patients.Methods:A retrospective analysis was made on 187 patients with hypertension crisis who were treated in the emergency department of our hospital from September 2021 to September 2022,including 42 hypertensive emergencies,145 hypertensive sub emergencies,and 30 patients with chronic renal insufficiency,secondary hypertension,and chronic cardiac insufficiency.115 hypertensive sub emergency patients were included.According to whether they were treated with flat car rest,they were divided into 62 flat car patients and 53 non flat car patients,Comparatively analyze the difference between the two groups in terms of blood pressure decline,emergency treatment time,emergency room access rate,medical expenses and other indicators.Multiple logistic regression was used to analyze the risk factors of patients transferred to the emergency room for treatment,and ROC curve was drawn to evaluate the predictive value of independent risk factors for the transfer to the emergency room for treatment.Results:There was no significant difference between the two groups in terms of age,male to female ratio,history of hypertension,symptoms,systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)at the time of preexamination.After 2h treatment,blood pressure(SBP,DBP and MAP)decreased more significantly in the flat car group,and the time for emergency consultation was shortened,the admission rate was lower,and the treatment cost was less,with statistical significance(P<0.05).Conclusion:For subemergency patients with hypertension,after pre examination and triage,flat car rest therapy is implemented,pushed by family members throughout the visit,combined with active oral drug treatment,the condition can be effectively alleviated,which is worthy of clinical promotion.For pre-examination triage MAP≥14lmmHg,it is recommended to directly enter the emergency room for venous antihypertensive therapy.
作者
刘海云
汪新财
黄龙
LIU Haiyun;WANG Xincai;HUANG Long(Department of Emergency,Fujian Provincial Hospital,Fuzhou,350028,China;Department of Critical Care Medicine,Fujian Provincial Hospital South Branch)
出处
《临床急诊杂志》
CAS
2023年第7期377-381,共5页
Journal of Clinical Emergency
