急诊抢救死亡病例7年变化趋势分析

Analyses of 7-year trends of died cases in emergency department

目的观察急诊科抢救的死亡病例的疾病谱和病死率变化趋势。方法将1998-2004年间在急诊科抢救的480例死亡病例分二个时间段和四个年龄组，比较疾病谱构成比和病死率。结果①各年龄组中，2002-2004年间构成比的排序从高到低为中年、青年、老年和高龄组，与1998-2001年间相比．中年组比例增高和老年组比例下降，有统计学意义（P〈0．01）；②各种外伤、循环和神经系统疾病居前三位，各种外伤、循环系统比例上升和神经系统比例下降，有统计学意义（P〈0．001）；③各年龄组病死率均下降，差异有统计学意义，中年组病死率最高（8.1％）；④各系统疾病的病死率除循环系统和各种中毒外，均呈下降趋势，差异有统计学意义，循环系统疾病的病死率最高（12．3％）；⑤各年龄组病死率居第一位的疾病，在青年组、中年组为循环系统疾病，老年组和高龄组均为各种中毒。结论为了降低急诊科抢救危重病的病死率，中年组是临床抢救的重点人群，循环系统和各种外伤是临床抢救的重点疾病，同时，应重视老年中毒患者。

Objective To observe the changes of disease spectrum and mortality of the died cases in emergency department. Methods 480 died cases in emergency department（from 1998 to 2004） were divided into four age groups and two time periods according to their ages and the times when they were treated. The composition and of the died cases were compared between groups. Results ①The proportions of the died cases for the mid--aged, youth, aged and advanced aged groups ranked the first to the fourth places （from 2002 to 2004）. The proportion of the died cases for the mid--aged group increased and aged group decreased （from 1998 to 2001）. The significant differences were found in the changes of died cases（ P〈0. 01 ）. ② The proportion of the died cases for trauma, the circulatory diseases and the nervous diseases ranked the first three place. The proportion of trauma and the circulatory diseases increased and that of the nervous diseases decreased, and thus there were the significant differences（ P 〈0. 001）. ③Mortality of all the age groups decreased. There were the significant differences. The fatality rate （8. 1%） of mid--aged group was the highest in four groups. ④The mortality for all systems decreased other than the circulatory diseases and acute poisoning. There were the significant differences. The mortality （ 12. 3% ） of the circulatory diseases was the highest in all systems.⑤In the youth and mid--aged groups, mortality for the circulatory diseases ranked the first place. In the aged and advanced aged groups, mortality for acute poisoning ranked the first place. Conclusions To lower the mortality of critical disease, emergency department should focus on the patients of the mid--aged groups and the circulatory diseases and trauma, acute poisoning in the aged group.