老年住院病人死亡的时间节律性研究

Analysis of Temporal Rhythm in the Death in Hospitalized Elderly Patients

目的了解中老年住院死亡病人的时间节律性分布,更全面地认识疾病的本质规律,审证求因,指导辨证论治。方法收集首都医科大学附属北京友谊医院老年医学科2009年8月8日—2013年8月8日60岁以上老年住院死亡病人(449例)的病历资料,分析病人死亡的二十四节气分布、年节律、日节律。结果肺部感染[175例(39.0%)]和恶性肿瘤[162例(36.1%)]是导致死亡的最主要原因。肺部感染死于二十四节气当日的病人高于恶性肿瘤(χ2=10.57,P=0.001)。春季和夏季肺部感染的死亡人数较高,夏季恶性肿瘤相关死亡人数较低。结论外感疾病中肺部感染受节气的影响更大。在肺部感染的辨证论治过程中,不应忽视相应的节气变化对机体阴阳平衡产生的影响;在治疗方面,也应始终考虑到温热毒邪的特点。老年晚期恶性肿瘤病人的辨证分型以阳虚为主,或为阴寒内盛,感受寒湿及痰饮为病属实者。

Objective To investigate the temporal rhythm distribution of the death in the elderly inpatients,and to understand laws of nature more comprehensively,request for the trial evidence,and guiding the treatment based on syndrome differentiation. Methods The clinical data of all the 449 dead cases in the elderly inpatients during the hospitalization from 2009 to 2013 were collected.The 24 solar term distribution,annual rhythm,rhythm of the death patients were analyzed. Results Pulmonary infection （175 cases,39.0%） and malignant tumor （162 cases,36.1% ） were the leading cause of death. On the same day of 24 solar,the number of death in the group of the pulmonary infection was higher than that of malignant tumor （χ2=10.57, P=0.001）. The death toll in the group of pulmo-nary infection was higher in the seson of spring and summer,the death toll of malignant tumor was lower in the seson of summer. Conclusion Exogenous diseases,such as pulmonary infection tend to be more influenced by solar term. In the differentiation of pul-monary infection effects,Pay more attention to the body balance of yin and yang changed by the solar term correspondingly. In aspect of the treatment,the characteristics of heat evil should always be considered. The syndrome differentiation in elderly patients with ad-vanced malignant tumor was yang deficiency syndrome,or yin-cold syndrome,cold-dampness syndrome and phlegm syndrome.