急诊留观患者的流行病学现状调查

A retrospective survey on epidemiological characteristics of emergency department patients

目的研究北京世纪坛医院近5年急诊留观患者的流行病学特点,以更好地加强该地区急诊专业的学科建设、提高医疗服务质量。方法回顾性选取首都医科大学附属北京世纪坛医院2014年1月1日-2018年12月31日就诊的急诊留观患者作为研究对象,统计分析其疾病谱及流行病学特点。结果 19 518例急诊留观患者中,男性(49.08%)和女性(50.92%)比例为1∶1.04;46~65岁组患者女性比例(47.28%)最低,>80岁组的女性患者比例(55.38%)高于46~65岁组和66~80岁组,差异有统计学意义(P<0.05)。在所有患者中>65岁老年患者比例为59.66%,2014年-2018年各年度老年患者就诊比例分别为53.86%、53.19%、57.00%、65.40%、68.79%,呈增高趋势(P=0.011)。呼吸系统疾病(24.20%)、循环系统疾病(23.67%)、消化系统疾病(14.47%)、神经系统疾病(12.75%)和内分泌系统疾病(7.08%)为主要疾病类型;第一诊断排名前10位的疾病分别为细菌性肺炎(14.72%)、急慢性心力衰竭(7.86%)、高血压急症(5.00%)、心律失常(4.02%)、冠状动脉粥样硬化性心脏病(3.92%)、慢性阻塞性肺疾病(3.01%)、脑血管疾病(2.68%)、消化道出血(2.66%)、糖尿病急症(2.43%)和腹腔感染(1.73%),占所有患者比例的48.02%。5年中冬季(12月-2月)总就诊人数为6 145人次,为全年患者最多季节,占总就诊人数的31.48%。结论根据疾病谱特点,应加强呼吸、循环、神经、消化、内分泌等各专科急症的培训;重视老年患者的救治;在冬季就诊高峰期,合理安排医护工作时间,优化诊疗流程。

Objective To investigate the epidemiological characteristics of patients in the emergency observation room of Beijing Shijitan Hospital during the last 5 years, to enhance the local and regional construction of education discipline and improve the quality of medical services. Methods A retrospective study was carried out on selected patients admitted to the emergency observation room of the Capital Medical University Affiliated Beijing Shijitan Hospital between January 1 st 2014 and December 31 st 2018. Statistical analysis was performed to identify associated epidemiological features in these patients. Results Among the 19 518 patients admitted to the emergency observation room, 49.08% were males and 50.92% were females, with a male to female ratio of 1:1.04. The 46-65 age group had the lowest proportion of females of 47.28%, while this proportion reached to 55.38% in the over-80 age group, which was higher than that in the 46-65 and 66-80 age groups, showing statistical significance(P<0.05). During the last 5 years,59.66% of the patients were aged above 65;the proportion of over 65 years old patients admitted to the emergency observation room of the hospital each year was 53.86%, 53.19%, 57.00%, 65.40%, and 68.79%, respectively, showing an increasing trend(P=0.011). Among the patients diagnosed, 24.20% had respiratory system diseases, 23.67% had circulation system diseases, 14.47% had digestive system diseases, 12.75% had neurological system diseases, and 7.08% had endocrine system diseases. According to the primary diagnosis, the top 10 most predominant diseases were bacterial pneumonia(14.72%), acute and chronic heart failure(7.86%), hypertension(5.00%), arrhythmia(4.02%), coronary atherosclerotic heart disease(3.92%), chronic obstructive pulmonary disease(3.01%), cerebrovascular disease(2.68%),gastrointestinal hemorrhage(2.66%), acute diabetes(2.43%), and celiac infection(1.73%), which accounted for 48.02% of the total patients admitted. In the winters(December to February) of these 5 years, the total number of patients admitted was 6 145, which contributed to 31.48% of the total admission number, and hence making winter the season with the highest number of patients seeking for medical services. Conclusions According to the spectrum of the disease features,there is a need to enhance the training of specialty and emergency clinics associated with respiratory, circulation,neurological, digestive, and endocrine diseases. Special attention should be paid for treatment and health care targeted at old-aged patients. During winter, the peak hospital visiting time, appropriate medical care service, which addresses the plan of working time, should be provided in order to optimize diagnosis and treatment processes.