2007至2014年住院儿童死亡原因分析

Characteristics of deaths occurring in hospitalized children between 2007 and 2014

目的了解住院死亡儿童的疾病特点，以提高对儿童危重症的识别和诊治水平。方法回顾性分析2007至2014年期间上海交通大学医学院附属新华医院住院死亡儿童的临床资料。结果451例住院患儿死亡，住院病死率0．58％（451／77838），其中〈5岁的死亡病例占76．27％（344／451）。导致住院患儿死亡的最常见的疾病依次为：肺炎38．80％（175／451），肿瘤13．75％（62／451），脓毒症11．97％（54／451），中枢神经系统感染8．00％（36／451）和意外伤害7．32％（33／451）。不同年龄死亡疾病的分布有显著差异：5岁以下以感染性疾病为主（66．86％，230／344），5岁以上以非感染性疾病为主（52．34％，56／107）。343例死亡患儿合并慢性基础疾病，其中婴儿期以先天性畸形为主（59．90％，115／192），幼儿和年长儿中以肿瘤最常见（34．36％，89／259）。结论不同年龄儿童死亡疾病分布显著不同，肺炎等感染性疾病是导致5岁以下儿童死亡的最主要原因，肿瘤和意外伤害事故是导致年长儿死亡的主要原因。大部分死亡患儿均合并慢性基础疾病，应根据不同年龄疾病特点，采取积极预防治疗措施。

Objective To improve the understanding of the characteristics of death in hospitalized children and provide clinical cautionary information to professional healthcare providers. Methods A retro- spective analysis was undertaken on the data of all children aged l month to 11 years who died at the Xinhua Hospital between 2007 and 2014. Demographic details, main causes of deaths, and chronic underlying diseases were reviewed. Results Case fatality rate was 0. 58% （451/77 838）. Overall, the most common causes of death in hospitalized children were pneumonia 38.80% （175/451 ）, tumor 13.75 % （62/451 ）, sepsis 11.97 % （54/451 ）, central nerve system infection 8. 00% （36/451 ） and accident 7. 32% （33/451 ）. Infectious diseases were the major causes of death in children younger than 5 years of age（66. 86% ,230/344 ）. In contrast, noninfectious diseases accounted for more deaths in children more than 5 years old（52. 34% ,56/107）. There were 343 death cases complicated with chronic underlying diseases. Congenital abnormality was the most fre- quent chronic underlying disease observed in infants （59. 90%, 1 ! 5/192） and tumor was the main chronic un- derlying disease in toddlers and elder children（34.36% ,89/259）. Conclusion Infectious diseases were the major causes of deaths, and the mortality in the study population decreased with age. Tumors and accidents accounted for more deaths in elder children. Chronic underlying diseases were found in most deaths of children. Efficient evaluation and effective intervention of these vulnerable children might save more lives.