【摘要】 目的 總結非器質性呼吸困難患者的急診診治經驗，提高急診醫生對心理-生理性疾病的認識。 方法 對2005年-2009年急診科32例非器質性呼吸困難患者的診治經過進行回顧性分析。 結果 32例患者發病前均有精神創傷或過度勞累、精神緊張、或應急等心因性誘因；有典型的臨床癥狀；過度通氣激發試驗陽性；血氣分析提示呼吸性堿中毒；Nijmegen問卷積分≤23分者18例（56.2%）；輔助檢查未見其他原發性疾病。 結論 隨著現代社會身心壓力的增大，非器質性呼吸困難患者明顯增加，臨床醫生應加強對社會心理-生理性疾病的認識，提高診斷率，對減輕患者的精神壓力及避免過度醫療具有重要的臨床意義。【Abstract】 Objective To summarize the medical experiences of treating nonorganic dyspnea in the emergency department and raise physicians’ awareness of psychological-physiological diseases. Methods The clinical data of 32 patients with nonorganic dyspnea between 2005 and 2009 in the emergency department of our hospital were analyzed retrospectively. Results All the 32 patients had psychogenic incentives before onset of the disease, such as mental injury, over-exhaustion, nervousness or emergency. All of them had typical clinical manifestations. The results of hyperventilation provocation test were positive. Arterial blood gas analysis implied respiratory alkalosis. Eighteen of them (56.2%) had a mark ≤23 on the Nijmegen questionnaire. Auxiliary examinations showed no other primary diseases. Conclusions With the increase of emotional stress in the modern society, the number of patients with nonorganic dyspnea have markedly increased. Clinicians should strengthen the awareness of social psychology-physiological diseases, and improve diagnostic accuracy, which will have an obvious clinical value in relieving patients’ mental stress and avoiding excessive medical treatment.
Objective To explore the predictive value of Composite Congestion Score (CCS) in predicting adverse events within 180 days in patients with acute heart failure (AHF) in emergency intensive care unit (EICU). Methods The patients with AHF who were admitted to EICU of Zigong Fourth People’s Hospital between January 1, 2018 and December 31, 2020 were included consecutively. The patients were followed up for 180 days, and were divided into poor prognosis group and good prognosis group according to whether there were adverse events. Logistic regression equation was used to screen independent risk factors for predicting adverse events in patients with AHF within 180 days after leaving EICU. To compare the discrimination, calibration and clinical usefulness of independent risk factors at EICU discharge and the Acute Physiology and Chronic Health Assessment SystemⅡ (APACHEⅡ) score at EICU admission to predict the occurrence of adverse events of AHF. Results A total of 71 patients were included, including 32 patients with good prognosis and 39 patients with poor prognosis. Except for age, APACHEⅡscore at EICU admission and CCS score at EICU discharge (P<0.05), there was no significant difference in other indicators between the two groups (P>0.05). Logistic regression analysis showed that CCS score at EICU discharge [odds ratio (OR)=2.806, 95% confidence interval (CI) (1.428, 5.512), P=0.003], age [OR=1.086, 95%CI (1.017, 1.159), P=0.013] were independent risk factors for predicting death or returning to hospital within 180 days. Among them, the CCS score at EICU discharge combining with age had a positive improvement ability compared with the CCS score at EICU discharge, the age, and the APACHE Ⅱ score at EICU admission. The calibration curves of the four scoring methods for predicting adverse events within 180 days showed that the CCS score at EICU discharge had the highest calibration and the calibration of age was the lowest. The decision curve showed that the clinical usefulness of age, the CCS score at EICU discharge and the CCS score at EICU discharge combining with age was better than the APACHE Ⅱ score at EICU admission. Conclusions The CCS score of patients with AHF at EICU discharge is closely related to adverse events within 180 days. The CCS score is designed based on clinical variables, simple and practical. The combination of age and the CCS score at EICU discharge will further enhance its clinical application value.