急诊危重症患者流行病学分析及疾病谱特点：附北京市1家医院2017年3176例急诊病例分析

Epidemiological analysis and disease spectrum characteristics of emergency patients with critical illness：3 176 emergency cases in 2017 in a hospital in Beijing were analyzed

目的 分析北京市1家医院2017年急诊危重症患者的流行病学特点及疾病谱.方法 回顾性分析2017年1月1日至12月31日首都医科大学宣武医院急诊抢救室收治的年龄≥14岁的3 176例危重患者的病例资料,包括性别、年龄、就诊时间、出院诊断、转归等,分析急诊危重症患者的流行病学特点、疾病谱分布,以及2017年全年及日均24 h急诊收治情况.结果 3 176例急诊危重症患者中,男性多于女性（例：1 824比1 352,1.35 ：1）;年龄14-100岁,平均（66.52±17.18）岁,高发年龄段为75-89岁（占35.2%,男性516例、女性603例）,其次为60-70岁（占30.0%,男性572例、女性381例）.急诊危重症患者疾病谱前4位分别是心血管系统疾病〔占41.8%,男性716例、女性610例,年龄（70.25±15.08）岁〕、神经系统疾病〔占26.7%,男性502例、女性346例,年龄（60.28±17.57）岁〕、呼吸系统疾病〔占12.3%,男性226例、女性166例,年龄（72.96±16.23）岁〕及消化系统疾病〔占5.6%,男性119例、女性60例,年龄（65.40±17.96）岁〕,四大系统疾病总占比为86.4%,均为男性多于女性（均P＜0.05）,且四大系统疾病患者年龄差异有统计学意义（F＝84.094,P＜0.001）.其中,心血管系统疾病以心律失常最多（16.7%）,其次为急性冠脉综合征（12.0%）和心力衰竭（9.1%）;神经系统疾病以脑卒中为主（20.9%）;呼吸系统疾病以重症肺炎为主（8.3%）;消化系统疾病以消化道出血为主（4.4%）.急诊危重症高发于冬季（12月为287例,1月为277例）及初春（3月为282例）;日高发时段以午后及夜间居多,尤其是18时至23时（18时为163例,19时为173例,20时为172例,21时为186例,22时为167例,23时为169例）.危重症患者在急诊抢救室平均治疗时间为1.5 d（最长23.0 d,最短6 min）,其中85.6%的患者3 d内可分流离开抢救室,1.9%的患者在抢救室滞留超过7 d.305例（占9.6%）死亡患者中以老年人为主,平均年龄（71.10±16.08）岁.结论 首都医科大学宣武医院急诊科2017年收治的急诊危重症患者的主要病因为心脑血管、呼吸及消化系统疾病,男性及老年患者多见;不同类型的急危重症患者好发年龄不同.

Objective To investigate the epidemiological characteristics of emergency critical illness and disease spectrum in emergency department of a hospital in Beijing. Methods A retrospective study was conducted. The data of 3 176 critically ill patients aged ≥ 14 years old admitted to the emergency room of Xuanwu Hospital Capital Medical University from January 1st to December 31st in 2017 were analyzed, including gender, age, clinical time, discharge diagnosis, outcomes, etc. To analyze the epidemiological characteristics and disease spectrum distribution of emergency critically ill patients, annual and daily 24-hour emergency visits in 2017 were analyzed. Results Among the 3 176 cases of acute critical illness, there were more males than females （1 824 vs. 1 352, 1.35 ： 1）; the age ranged from 14 to 100 years old, with an average of （66.52±17.18） years old; the highest incidence age was 75-89 years old （35.2%, 516 males and 603 females）, followed by 60-70 years old （30.0%, 572 males and 381 females）. The top four prevalence diseases in the emergency critical disease spectrum were cardiovascular diseases [41.8%, 716 males and 610 females, age （70.25±15.08） years old], nervous system diseases [26.7%, 502 males and 346 females, age （60.28±17.57） years old], respiratory disease [12.3%, 226 males and 166 females, age （72.96±16.23） years old] and digestive system diseases [5.6%, 119 males and 60 females, age （65.40±17.96） years old], accounting for 86.4% of the total. There were more males than females （all P 〈 0.05）, and the age difference was statistically significant （F = 84.094, P 〈 0.001）. Arrhythmia was the most common cardiovascular disease （16.7%）, followed by acute coronary syndrome （12.0%） and heart failure （9.1%）; the main nervous system diseases were stroke （20.9%）; respiratory diseases mainly included severe pneumonia （8.3%）; digestive system diseases were mainly with digestive tract bleeding （4.4%）. The high incidence of acute critical illness in the emergency department occurred in winter （287 cases in December and 277 cases in January） and the early stage of spring （282 cases in March）. The daily peak period was midday and at night, especially from 18：00 to 23：00 （163 cases at 18：00, 173 cases at 19：00, 172 cases at 20：00, 186 cases at 21：00, 167 cases at 22：00, 169 cases at 23：00）. The average treatment time of critically ill patients in emergency room was 1.5 days （the longest was 23.0 days, the shortest was 6 minutes）, among them, 85.6% of the patients could be discharged from the emergency within 3 days, and 1.9% of the patients stayed in the emergency for more than 7 days. There were 305 deaths （9.6%）, mainly among the elderly, with an average age of （71.10±16.08） years old. Conclusions Cardiovascular and cerebrovascular diseases, respiratory and digestive diseases are the main causes of acute critical diseases in department of emergency of Xuanwu Hospital Capital Medical University in 2017. Male and elderly patients are more common; different types of acute and severe patients tend to attack at different ages.