目的：对1764例急诊内科疼痛患者的临床资料进行总结，探讨24 h内死亡与病因的关系。方法以疼痛为最主要痛苦，疼痛部位主要包括头痛、胸背痛、腹痛，共收集2012年11月—2013年11月开封市中心医院急救中心收治的1764例患者的临床资料进行回顾性分析。按原发疾病分组，计算不同病因组镇痛剂使用率、3 h疼痛不缓解或复用镇痛剂率及24 h病死率。结果急诊内科疼痛患者占急诊总量的10.61％（1764/16627），占急诊内科患者的20.71％（1764/8519）。1764例患者镇痛剂使用率为27.10％（478/1764），3 h疼痛不缓解或复用镇痛剂率为14.97％（264/1764），24 h病死率为2.38％（42/1764）。常见病因组与非常见病因组镇痛剂使用率比较，差异无统计学意义（χ2＝1.79，P＝0.18）；两组3 h疼痛不缓解或复用镇痛剂率、24 h病死率比较，差异有统计学意义（χ2＝16.17、15.07，P＜0.05）。多因素Logistic回归分析结果显示，急性冠脉综合征（ ACS）、高血压急症、出血性脑血管疾病、心包炎、肺栓塞、自发性气胸、主动脉夹层、其他病因是影响急诊内科疼痛患者24 h死亡的因素（ P＜0.05）。结论影响急诊内科疼痛患者24 h死亡的病因包括主动脉夹层、心包炎、肺栓塞、自发性气胸、出血性脑血管疾病、ACS、高血压急症、其他病因。急诊医生在镇痛剂应用中更偏向保守，有必要制定急诊镇痛的指南指导急诊医生临床用药。%Objective To review the clinical data of 1 764 emergency patients with pain complaints caused by internal medicine diseases and investigate the relationship between death within 24 hours and pathogeny. Methods The data of 1 764 patients who were admitted by the Department of Emergency of the Central Hospital of Kaifeng from November 2012 to November 2013 were retrospectively analyzed. The inclusion criterion was pain being the primary complaint and pain mainly in the head, chest,back and abdominal part. The subjects were divided into groups by primary diseases. The rate of analgesic usage,the rate of pain without alleviation after 3 hours or the reuse of analgesic and the mortality rate within 24 hours of each group were calculated. Results Subjects suffering pain caused by internal medicine diseases accounted for 10. 61%(1 764/16 627)in all emergency patients and 20. 71%(1 764/8 519) in all emergency patients with internal medicine diseases. The rate of analgesic usage was 27. 10%(478/1 764);the rate of pain without alleviation after 3 hours or the reuse of analgesic was 14. 97%(264/1 764);the mortality rate within 24 hours was 2. 38%(42/1 764). There was no statistically difference(χ2 =1. 79,P =0. 18) between the common pathogeny group and the uncommon pathogeny group in the rate of analgesic usage;there were significant differences(χ2 =16. 17,15. 07;P <0. 05) between the two groups in the rate of pain without alleviation after 3 hours or the reuse of analgesic and the mortality rate within 24 hours. The multivariate Logistic regression analysis showed that ACS, hypertension emergency, hemorrhagic cerebrovascular disease, pericarditis, pulmonary embolism, spontaneous pneumothorax,aortic dissection and other pathogenies were influencing factors( P<0. 05 ) for the death of emergency patients suffering pain caused by internal medicine diseases within 24 hours. Conclusion The risk factors for the death of emergency patients suffering pain caused by internal medicine diseases are respectively aortic dissection, pericarditis, spontaneous pneumothorax,hemorrhagic cerebrovascular disease,ACS,other pathological causes and hypertension emergency. Physicians in emergency department are more conservative in using analgesic. A clinical guideline for analgesia in emergency department should be made to guide physicians in clinical administration.
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