成都市老年与非老年院前急救患者流行病学分析

Epidemiological analysis of pre-hospital emergency elderly and non-elderly patients in Chengdu

目的调查成都市院前急救患者流行病学情况,探讨该市老年与非老年院前急救患者的特点。方法回顾性收集成都市120急救系统数据库中2017年度院前急救的全部记录,根据患者年龄分为老年组(≥60岁)和非老年组(<60岁)。比较两组患者的疾病谱构成、呼救数量及不同病种随时间变化的趋势和死亡患者病种构成差异。结果共纳入179 387例院前急救患者,老年组59 980例,非老年组119 407例。老年组及非老年组均以男性居多,老年组以60~89岁为主,非老年组中主要为18~59岁的青壮年患者。老年组院前急救患者以创伤类疾病(29.19%)、神经系统疾病(14.64%)、症状体征类疾病(13.82%)、心血管系统疾病(12.86%)为主,非老年组中以创伤类疾病(50.89%)、急性中毒(10.98%)、症状与体征类疾病(10.08%)为主。院前死亡患者中以老年组[7 043例(69.61%)]居多,死亡率为11.74%,其中以猝死(死亡原因不明)(28.70%)、心血管系统疾病(25.95%)、呼吸系统疾病(16.07%)为主,非老年患者院前死亡率为2.58%,以创伤类疾病(35.41%)、猝死(死亡原因不明)(25.33%)、心血管系统疾病(17.56%)为主。老年组患者呼救数量主要于9月开始逐渐增多,至12月达高峰,2月为最低;而非老年组患者,其呼救高峰出现在7月,同样于2月降至最低;老年组患者呼救数量所占比例于1月-2月、10月-12月偏高,非老年组于7月出现高峰。老年组患者呼救数量主要集中于白昼时段(08:00-20:00),非老年组患者白昼呼救数量变化趋势与老年患者相似,但其于夜间20:00-24:00时段再次出现呼救高峰;老年组患者呼救数量所占比例于06:00-09:59为高峰时段,而非老年组患者的高峰时段是凌晨(00:00-04:59)及夜间(20:00-23:59)。结论老年和非老年患者院前急救的数量在时间、疾病谱的分布上各具特点,创伤类疾病、心血管系统疾病分别是成都市最常见的院前急救原因及死亡原因,并且老年患者院前死亡率远远大于非老年患者,相关部门可据此合理配置急救资源,重点提高相关疾病的现场救治能力。

Objective To investigate the epidemiological situation of pre-hospital emergency elderly and nonelderly patients in Chengdu and explore the characteristics of pre-hospital care in the city. Method All pre-hospital care records in the Chengdu 120 Emergency System Database in 2017 were retrospectively collected. According to the age of the patients, they were divided into the elderly group(≥60 years old) and the non-elderly group(<60 years old). The disease spectrum, the trends of the number of emergency help calls, the changes in different diseases over time, as well as the disease composition of the patients who died in the two groups were compared. Results A total of 179 387 pre-hospital emergency patients were enrolled, including 59 980 elderly patients and 119 407 non-elderly patients. Most of them were male patients in both groups. Patients in the elderly group were mainly between 60 to 89 years old, and the ones in the non-elderly group were mainly between 18 to 59 years old. The pre-hospital emergency patients in the elderly group presented with trauma, nervous system, symptoms and signs, and cardiovascular system diseases mainly, accounting for29.19%, 14.64%, 13.82%, and 12.86%, respectively. In the non-elderly group, trauma, acute poisoning, and symptoms and signs were predominant, accounting for 50.89%, 10.98%, and 10.08%, respectively. Among the pre-hospital deaths, the number in the elderly group was the larger, accounting for 69.61%(7 043 cases);the mortality rate was 11.74%, with sudden death(28.70%), cardiovascular diseases(25.95%), and respiratory diseases(16.07%) being the major causes. The pre-hospital mortality rate of non-elderly patients was 2.58%, mainly including traumatic diseases(35.41%), sudden death(unknown cause of death)(25.33%), and cardiovascular diseases(17.56%). The number of emergency help calls in the elderly group began to increase gradually from September, reaching a peak in December and hitting the trough in February. While in the non-elderly group, the peak of the emergency help calls appeared in July, and it also fell to the lowest in February. The proportion of the number of emergency help calls in the elderly group was higher in January to February and October to December;while the peak in non-elderly group was in July. The number of emergency help calls in the elderly group were mainly concentrated in the daytime(08:00 to 20:00). In the non-elderly group, the changes in the number of emergency help calls were similar to that of the elderly, however, with another peak(20:00 to 24:00). The proportion of the number of emergency help calls in the elderly group was 06:00 to 09:59, and the peak time of the nonelderly group was in the early morning(00:00 to 04:59) and night(20:00 to 23:59). Conclusions The number of prehospital care for elderly and non-elderly patients has its own characteristics in terms of the time and the distribution of disease spectrum. Trauma and cardiovascular diseases are the most common causes of pre-hospital care and death in Chengdu. And the pre-hospital mortality in the elderly group is much larger than that in non-elderly group. Relevant departments can allocate emergency resources rationally, and focus on improving the on-site rescue capacity towards related diseases.