陕西省某三甲医院2011年-2019年住院死亡病例分析

Analysis of Inpatient Deaths in a Hospital in Shaanxi Province from 2011 to 2019

目的 分析2011年1月1日-2019年12月31日某院住院死亡病例死因构成及特征,探讨住院死亡疾病特点和变化趋势,为医院质量管理和学科建设提供新思路。方法 调取陕西省某三甲医院2011年1月1日-2019年12月31日期间7490例死亡患者的全死因数据,根据国际疾病分类标准ICD-10进行编码分类,采用SPSS24.0统计分析软件对死因及人群基本资料进行流行病学回顾性统计分析,采用Cox-Stuart检验分析不同年份的死亡趋势。结果 2011年-2019年该院平均住院病死率为0.89%,呈逐年下降的趋势。老年患者占总死亡的79.94%;儿童期死亡占比最低,为0.32%。特殊人群新生儿病死率最高的是特发于围生期的呼吸和心血管疾患(55.60%),其次是围生期的感染(20.40%),第三是胎儿和新生儿出血性和血液学疾患(7.40%)。产妇死亡情况主要归为三类:产科合并其他疾病占60.00%(妊娠伴脑出血2例,妊娠伴心脏病2例,妊娠合并胰腺炎1例,妊娠合并病毒性感染1例);产褥期并发症占30.00%(羊水栓塞3例);妊娠高血压占10%(Hellp’s综合征1例)。损伤中毒意外死因中跌倒居于第1位占比41.75%,运输事故占比24.84%,加害居于第3位,占比24.00%。结论 首先,改善老年人群的医疗救治和健康干预才能降低病死率,减轻疾病负担。其次,建立预警评估机制、多学科协作、建立快速反应团队对于特殊人群的救治及管控低风险死亡率有着至关重要的作用。

Objective By analyzing the cause and characteristics of inpatient deaths in a hospital from January 1,2011 to December 31,2019,so as to provide new ideas for hospital quality management and discipline construction.Methods 7490 inpatients deaths in the hospital in Shaanxi Province from January 1,2011 to December 31,2019 were collected.According to the ICD-10,the cause of death and basic information of population were analyzed retrospectively by SPSS24.0 statistical analysis software.The trend of death in different years was analyzed by Cox-Stuart test.Results From 2011 to 2019,the average inpatient mortality was 0.89%,showing a decreasing trend year by year.The elderly patients accounted for 79.94% of the total deaths;The proportion of childhood deaths was the lowest(0.32%).The highest neonatal mortality rate in the special population was for respiratory and cardiovascular diseases specifically occurring in the perinatal period(55.60%),followed by perinatal infections(20.40%),and fetal and neonatal hemorrhagic and hematological diseases(7.40%).Maternal deaths were mainly classified into three categories:obstetrics combined with other diseases accounted for 60.00%(There were 2 cases of pregnancy with cerebral hemorrhage,2 cases of pregnancy with heart disease,1 case of pregnancy with pancreatitis and 1 case of pregnancy with viral infection);Puerperium complications accounted for 30.00%(Amniotic fluid embolism 3 cases);Pregnancy hypertension accounted for 10%(Hellp’s syndrome:a case).Fall was the first cause of death in poisoning accidents,accounting for 41.75%,transportation accidents accounted for 24.84%,and injuries ranked the third,accounting for 24.00%.Conclusions First of all,to improve the medical treatment and health intervention of the elderly population can reduce the case fatality rate and reduce the burden of disease.Secondly,the establishment of early warning and evaluation mechanism,multidisciplinary collaboration and rapid response team plays a vital role in the treatment and control of low-risk mortality in special populations.