摘要
目的 对某三级综合医院住院死亡病例进行流行病学分析,了解住院死亡患者死因谱的发展变化情况,为医院疑难危重病例救治能力评估提供参考数据.方法 利用该院病案统计管理系统收集2020-2022年全部住院死亡病例住院信息,按照疾病和有关健康问题的国际统计分类(ICD-10)进行疾病分类,采用统计分析软件SPSS 23.0进行统计分析.结果 2020-2022年,该院出院总人次为306 756人次,住院死亡总人数为1 522人,病死率4.96‰;3年间病死率呈逐年下降趋势,各年份病死率差异有统计学意义(x2=18.470,P＜0.001).男性患者病死率6.35‰,女性患者病死率3.57‰,男性患者病死率高于女性患者,差异有统计学意义(x2=119.501,P＜0.001).不同年龄组间病死率存在差异,病死率最高的组别为小于28 d的新生儿组,病死率为30.91‰,其次是≥80岁年龄组,病死率为17.84‰,不同年龄组间的差异有统计学意义(x2=1 367.76,P＜0.001);住院患者死亡原因顺位前3位分别为循环系统疾病(24.24％),呼吸系统疾病(21.16％),恶性肿瘤(20.83％);不同年龄组死因构成不同,新生儿组(小于28 d)主要死因为特发于围生期的呼吸疾患,主要是新生儿呼吸窘迫综合征和新生儿窒息;28 d～＜1岁组死于呼吸系统疾病的人数最多,20～79岁组主要死因为恶性肿瘤和循环系统疾病,≥80岁以呼吸和循环系统疾病为最主要死因.结论 循环系统疾病、呼吸系统疾病和恶性肿瘤是该医疗机构最主要的死亡原因,医疗机构应根据死因分布情况,加强相关疾病防治工作,开展健康干预和健康教育,降低高危人群的发病风险;同时针对不同疾病特点,优化诊疗流程,加强医疗资源配置,持续改进医疗服务质量.
Abstract
Objective To analyze inpatient death cases in a tertiary comprehensive hospital during the three-year period from 2020 to 2022 and provide reference data for the evaluation of the hospital's ability to treat difficult and critical cases.Meth-ods The basic information of all inpatient deaths during the three-year period from 2020 to 2022 was collected using the hospital's medical record statistical management system.The cases were classified according to the International Classification of Diseases(ICD-10)and analyzed using statistical analysis software SPSS 23.0.Results From 2020 to 2022,there were a total of 306 756 discharged patients and 1 522 inpatient deaths,with a total mortality rate of 4.96‰.The mortality rate showed a decrea-sing trend each year,and there were significant differences in mortality rates between the years(X2=18.470,P＜0.001).The mortality rate of male patients was 6.35‰,higher than that of female patients(3.57 ‰),and the difference was statistically sig-nificant(x2=119.501,P＜0.001).There were differences in mortality rates among different age groups.The group with the highest mortality rate was the newborn group(less than 28 days old),with a mortality rate of 30.91‰.The second highest mor-tality rate was in the age group over 80 years old,with a mortality rate of 17.84‰.The differences in mortality rates between dif-ferent age groups were statistically significant(x2=1 367.76,P＜0.001).The top three causes of death in hospitalized patients were circulatory system diseases(24.24％),respiratory system diseases(21.16％),and malignant neoplasms(20.83％).The causes of death were different between age groups.In the newborn group(under 28 days),some conditions originating in the perinatal period were the main cause of death.The group aged 28 days to under 1 year old had the highest number of deaths due to respiratory diseases,while malignant tumors and circulatory system diseases were the main causes of death in the age group be-tween 20 and 79 years old,and respiratory system diseases and circulatory system diseases were the main causes of death for those aged 80 years old and above.Conclusion Circulatory system diseases,respiratory system diseases,and malignant tumors were the main causes of death.According to the distribution of causes of death,medical institutions should strengthen the preven-tion and treatment of chronic diseases,carry out personalized health interventions and health education,and reduce the risk of dis-ease in high-risk groups;at the same time,according to the characteristics of different diseases,they should optimize the diagnosis and treatment process,strengthen the allocation of medical resources,and continuously improve the quality of medical services.
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