老年住院患者474例死亡病例分析

Analysis of 474 Hospitalized Elderly Death Cases

目的近年来我国人口老龄化问题日益严峻,如何提高老年患者疾病救治率,合理分配有限的医疗卫生资源,最大限度地满足老年人的健康需求,显得尤为重要。本文通过分析上海交通大学医学院附属新华医院老年科老年住院患者死亡原因特征及变化趋势的分析,为做好老年疾病的防治工作提供一定的理论依据。方法 回顾性分析2012年3月-2019年2月我院老年科住院死亡患者临床资料474例。按照年龄分为3组,(60~79)岁组27例,(80~89)岁组259例,≥90岁组188例。采用ICD-10为疾病分类原则,对死亡年龄、病死率、死亡季节分布、死亡原因系统疾病、死亡病种情况等进行统计分析。结果 7年间我院老年科收治患者4 942例,死亡474例,病死率为9.6%,平均死亡年龄(88.19±5.38)岁。冬季(12月-2月)病死率最高,夏季病死率较低,统计分析显示各季节病死率差异无统计学意义。呼吸系统疾病死亡比例最高,其次为恶性肿瘤、循环系统、消化系统、神经系统等疾病。肺部感染是各年龄组老年住院患者死亡病种第1位。80岁以上老年患者第2至4位死亡病种依次是急性心肌梗死、肺栓塞和肺癌。结论呼吸系统疾病、恶性肿瘤是老年患者常见死因原因。重视老年患者综合评估、合理用药,加强保健防病宣教,开展定期门诊随访和健康体检,对降低老年患者死亡率有积极意义。

Objective To analyze the death cause of hospitalized elderly so as to provide theoretic basis for prevention and treatment of geriatric diseases.Methods A retrospective analysis was made to the clinical data of 474 hospitalized elderly death cases during the period from Mar.,2012 to Feb.,2019;the cases were divided into 3 groups:group of 60 to 79 years old(n=27),group of 80 to 89 years old(n=259) and group of 90 years old and over(n=188);taking international classification of diseases(ICD-10) as the principle of disease classification,the death age,mortality,seasonal distribution of death,systematic diseases in death cause and the diseases causing death were statistically analysis.Results There were 4 942 elderly hospitalized in geriatric department in the 7 years,in which 474 died,the mortality was 9.6% and the average death age was 88.19 years;the mortality was the highest in winter(from Dec.to the next Feb.) while lower in summer,the difference in mortality in each season was of no statistical significance;the respiratory diseases took the largest proportion of death,followed by malignant tumor,diseases of circulation system,diseases of digestive system ad nervous system;lung infection took the first place among death causes in groups of different ages;acute myocardial infarction,pulmonary embolism and lung cancer took the second and the third place among death causes in the elderly over 80 years old.Conclusions Respiratory disease and malignant tumor are the common death causes in the elderly;more attention should be paid to the general estimation of elderly cases,rational medication,education of health care and disease prevention,regular outpatient follow-up and physical examination,which is of positive significance in reducing the mortality in the elderly.