住院死亡病例直接死因分析

Analysis of Direct Cause of Death about Dead Cases

目的分析住院患儿死亡原发疾病谱,探讨如何寻求患儿直接死亡原因及如何规范死亡病例讨论。方法对本院227例死亡病例进行回顾性分析,根据死亡病例的原始病历资料及死亡病例讨论,分析推断直接死因。结果 227例死亡病例中,婴幼儿占总数的70%;PICU 157例(69.2%);原发疾病中前3位是神经系统疾病(颅内感染、肿瘤、出血、外伤)55例(24.2%),先天畸形(先天性心脏病、先天性消化道畸形)53例(23.3%)及呼吸系统疾病(感染、吸入等)47例(20.7%);推断分析出直接死因的病例67例(占29.5%),其中前3位分别是窒息21例、脑疝17例、大出血致失血性休克8例。结论神经系统疾病是危及危重症患儿生命的主要疾病,是目前研究的重点方向;同时死亡病例讨论作为医院核心制度,其核心是寻求直接死因,这需要相关科室参与诊治及抢救医师共同参与,掌握正确并行之有效的分析方法,而寻求直接死因关键在于抓住病情恶化的时间点。

Objective To investigate the trends in the change of spectra of cause of death among hospitalized children, analyze and discuss how to seek direct cause of death and how to regulate death case discussions. Methods A retrospective analysis was reviewed of 227 dead cases in Children＇s Hospital of Chongqing Medical University. Of which, these were analyzed for seeking direct cause of death according to the original medical records. Results Of the total 227 cases,70% patients were infants whose age ≤ 3 years old;!57 children （69.2%） were dead in pediatric intensive care unit. The three most frequent primary diseases were nervous system diseases including infection, tumor, bleeding and trauma（55 cases,24.2% ）, congenital malformation including congenital heart disease and alimentary tract malformation（53 cases,23.3 % ）, and respiratory system diseases （47 cases,20.7 % ） ; Furthermore, among 227 patients, 67 cases （ 29.5 % ） could be found di- rect cause of death, the top three direct cause of death were asphyxia （21 cases）, cerebral hernia （17 cases）, and uncontrolled hemorrhagic shock （8 cases）. Conclusions Disease of the nervous system is a serious danger to critically ill children, which needs further study. Meanwhile death case discussions is an important part in hospital core system, the aim is to look for direct cause of death, which requires related departments and physicians who participated in rescue and treatment and all of doctors master correct and effective methods. The key to look for direct cause of death is catching hold of the patient＇s deteriorating time.