老年发热待查住院患者流行病学资料分析

An Epidemical Analysis on the Senior Inpatients with Unknown Fever

目的探讨2006年以发热待查收住院老年患者的流行病学病因。方法病例选自2006年1月1日-2006年12月31日期间,以发热待查收住干部科病房的患者。将入选病例分为老年组(年龄≥65岁)和对照组(年龄<65岁)。统计学处理应用SPSS软件,回顾性分析并比较不同年龄患者的发热病因、住院天数和医疗费用。结果老年组中存在感染危险因素的比例为86.9%(73/84),明显高于对照组29.4%(10/34)。老年组中最常见的危险因素依次为脑梗塞26.0%(19/73)、糖尿病19.2%(14/73)、冠心病19.2(14/73)、恶性肿瘤9.6%(7/73)和充血性心力衰竭8.2%(6/73)。结论感染性疾病是发热待查的主要病因,呼吸道感染以肺部感染多见。胆道和泌尿系感染、肿瘤性疾病及结核病仍是发热的常见病种,特别是老年人。并且老年病人多存在感染的危险因素或基础病。加强对老年人感染性疾病的防治力度,是降低平均住院日,提高临床疗效性价比的重要措施之一。

Objective To analysis the reason of fever in the elderly. Method Totally 118 cases of fever admitted in General Practice Department of Beijing Chaoyang hospitals from January 2006 to December 2006 were reviewed. We retrospectively divided these patients into elderly group （age 〉 = 65yr） and non - elderly group （age〈 65yr）, then compared their etiology of fever, hospital stay and therapeutic cost. Result The causes of fever were identified in 109 cases （92.4%）. Infection was the most common reason in both of the two groups, which were in 80.0% （68/84） and 82.4% （28/ 34） of the patients respectively. In elderly group, the focus of the infection included respiratory tract （79.4 % ）, biliary passage （8.8 % ）, urine tract （7.4%）. Tuberculosis contributes to the fourth reason （4.4%） of the infection disease. Tumor was the most common non - infection reason in elderly group （3.1% ）. In non- elderly group, pulmonary infection was the primary cause of fever, and mycoplasma was the most common pathogen （50. 0% ）. The other infections were mostly seen in urine tract （21.4%）, intestinal tract（7.2% ）. There were 8.8 % patients had a fever due to a tumor. In elderly group, 73 cases （86.9%）had one or more risk factors to infection, the most common risk factors were cerebral infarction 26.0% （19/73）, diabetesl9.2% （14/73）, coronary heart disease 19.2（14/73）, malignancy 9.6% （7/73）and congestive heart failure 8.2% （6/73）in order. In the non - elderly group, 29.4% （ 10/34）patients had these risk factors, which were significantly fewer than elderly group（ P 〈 0. 001 ）. Conclusion Infectious disease is the primary cause of fever, in which respiratory tract is the predominant part of the infection. In non - elderly patients, mycoplasma is the most popular pathogen. Infection of biliary passage and urine tract, malignancy and tuberculosis also are the frequent reasons of the fever, especially in the elderly who generally has risk factors or underlying diseases. Enhancing the prevention and treatment to the infection in the elderly is the impotent approach to decrease hospital stay days, save medical resources and increase cost - effective ratio.