在接受机械通风的退伍军人尸检时,可以治疗的腹部病理状况和未被怀疑的恶性瘤
M A Papadakis1, C M Mangione, K K Lee
1Department of Medicine, University of California, San Francisco.
JAMA
|February 20, 1991
概括
尸检时的意外诊断,特别是腹部疾病,经常导致机械通风患者的可预防死亡. 在18%的病例中,改善诊断准确度可能会改变治疗方法.
科学领域:
- 医学研究 医学研究
- 关键护理医学 关键护理医学
- 病理学 病理学 病理学
背景情况:
- 机械通风是重症患者的关键干预措施.
- 尸体解剖研究揭示了意想不到的诊断,影响了患者的结果.
- 识别诊断错误对于改善患者护理至关重要.
研究的目的:
- 确定机械通风患者尸检时重大意外诊断的频率和类型.
- 为了确定可能改善生存率 (I类错误) 或改变管理 (IIB类错误) 的诊断,如果在死亡前已知.
主要方法:
- 追溯的队列研究.
- 分析了来自六个医疗重症监护室的172名尸检患者.
- 包括接受机械通风并在医院死亡的退伍军人.
主要成果:
- 一级错误率为12%,腹部疾病 (,穿孔,心脏病发作) 和肺栓塞是常见的原因.
- 腹部疼痛经常被注意到,但腹部检查并不显著,导致错过诊断.
- 类IIB错误 (改变治疗方法但没有生存) 发生在6%的患有广泛恶性瘤的患者中.
结论:
- 可治疗的腹部疾病的非典型呈现是机械通风退伍军人可预防死亡的常见原因.
- 无法识别的终端疾病导致一些患者进行了密集的干预.
- 在死亡之前对尸检结果的了解可能会在18%的患者中实质性地改变治疗方法.
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