解放军总医院呼吸科监护室住院患者死亡规律分析

Death patterns of patients in Department of Respiratory Care Unit of General Hospital of PLA

目的通过回顾性分析解放军总医院呼吸科监护室1495例住院患者中253例死亡特点、不同影响因素死亡风险及死亡时间规律,寻找工作弱点,以期提高工作质量,降低死亡率。方法从医院信息系统（HIS）中提取住院患者资料,按照不同时间划分方法进行分类统计。结果每年11月至次年3月死亡率高于其他月份,为19.5%（P〈0.05）。8∶01-9∶00及23∶01-24∶00入院死亡率高（P〈0.05）,分别为41.7%和50.0%。周内各天死亡率差异有统计学意义（P〈0.01）,周六死亡率最高,为43.1%。0∶01-1∶00、4∶01-5∶00、9∶01-10∶00、13∶01-14∶00死亡构成比较大（P〈0.05）,分别为7.1%、7.1%、6.7%、6.7%。非工作日死亡率（38.3%）高于工作日死亡率13.2%（P〈0.01）。非工作时间死亡率（31.3%）高于工作时间（工作日8∶00-11∶30,14∶30-18∶00）死亡率（5.2%,P〈0.01）。Logistic回归分析提示,年龄、入院月份、出院时间是否为工作时间对预后的影响差异有统计学意义（P〈0.05）,OR值分别为1.06、1.07、0.08。结论每年11月至次年3月死亡率高,与冬季呼吸系统疾病高发,寒冷天气使得机体循环阻力增大,调节失衡及大气污染相关。年龄因素、入院月份、出院时间是否在工作时间与预后相关。死亡率与医护人员工作结构明显相关,因此,提高医护人员工作质量,合理安排医护力量,对于改善患者预后,降低死亡率有很大作用。

Objective To analyze retrospectively the death pattern, risk factors, and death time of 253 patients at the Respiratory Care Unit of General Hospital of PLA in order to improve care quality and reduce mortality. Methods The information of patients was extracted from the hospital information system （HIS）, and then classified and calculated according to different time points. Results Between November and next March, the mortality rate was higher than in other months （P 〈0.05） , accounting for 19.5%. Mortality of those admitted between 8：O1 and 9：00 or between 23：01 and 24：00 was higher than at other times（ P 〈 0.05 ）, accounting for 41.7% and 50.0%, respectively. There was statistically significant difference（ P 〈 0.01 ） in mortality between days of the week ,with the highest on Saturday, accounting for 43.1%. Mortality on non-work days was higher than on workday（ P 〈 0. 01 ） , accounting for 38.3% and 13.2% , respectively. Mortality at off-hour was higher than at office time（8：00 - 11：30 and 14：30 - 18：00 on workday） （P 〈0. 01 ）, accounting for 31.3% and 5.2%, respectively. Logistic regression analysis showed that age, month of admission, and the hour of discharge were associated with the outcome. Conclusion The high mortality between November and next March may be related to the higher incidence of respiratory diseases in winter, air pollution and cold weather. High mortality is also significantly associated with the care quality of the medical staff.