复杂共病环境下心脑血管疾病共存住院患者诊治分析

Diagnosis and treatment of inpatients with cardiovascular and cerebrovascular diseases in complex comorbid environment

目的分析住院且诊断为心脑血管疾病患者临床特征及其差异,为心脑血管疾病多病共存患者的就医选择和临床诊疗策略提供支持。方法在2012年1月至2019年12月在本院神经内科和心内科1年内就诊过的275例患者纳人研究,采用回顾性分层分析比较两科室就诊、住院及其转归情况。结果275例就诊患者在心内科诊疗时,主要诊断为循环系统疾病(100-199)253例(92.0%);在神内科诊疗时,主要诊断分别为循环系统疾病(100-I99)、神经系统疾病(G00-G99),累及循环和呼吸系统、认知、知觉、情绪状态和行为的症状和体征(R00-R09、R40-R46),占69.8%(192例)、16.7%(46例)和13.1%(36例)。两科室其他诊断数量的分布差异有统计学意义(X^(2)=67.8,P<0.001),心内科5个以上其他诊断比例较高[153例(55.6%)比59例(21.5%)],神内科2~4个其他诊断比例较高(64.0%比36.4%);在心内科诊疗时,两组其他诊断个数的分布差异有统计学意义(X^(2)=9.3,P=0.03),神经内科首诊组1个其他诊断的比例较高,2个以上其他诊断比例较低;患者在两科住院天数差异无统计学意义(X^(2)=2.2,P=0.14),但转归差异有统计学意义(X^(2)=4.6,P=0.03)神内科未愈或死亡比例较低;在两次住院时间间隔180d(ײ=0.1,P=0.72)和90d(X²=1.8,P=0.18),两组的比例差异无统计学意义。结论心脑血管疾病共存患者的早防早诊早治仍需加强,多病联合诊疗可能是突破目前单病种诊疗模式的有益探索。

Objective To analyze the clinical characteristics and differences of inpatients who have been diagnosed with both cardiovascular and cerebrovascular diseases.The findings from this study will help medical professionals make informed decisions regarding diagnosis and treatment strategies for patients with coexisting cardiovascular and cerebrovascular diseases.Methods sThis study included a total of 275 patients who were hospitalized in both the Neurology and.Cardiology Departments of our hospital between January 2012 and December 2019.The study compared the treatment,hospitalization,and prognosis of the two departments using retrospective stratified analysis.Results The majority of patients hospitalized in the Cardiology Department were diagnosed with circulatory system diseases(100-199),accounting for 92.0%(253 cases).In the Neurology Department,the main diagnoses were circulatory system diseases(I00-199),nervous system diseases(Goo-G99),symptoms and signs involving circulatory and respiratory systems,cognition,perception,emotional state and behavior(R00-R09,R40-R46),accounting for 69.8%(192 cases),16.7%(46 cases)and 13.1%(36 cases),respectively.There was a significant difference in the distribution of diagnoses between the Cardiology and Neurology Departments(X?=67.8,P<0.001).The Cardiology Department had a higher proportion of patients with 5 or more other diagnoses153(55.6%)us.59(21.5%),while Neurology Department had a higher proportion of patients with 2-4 other diagnoses(64.0%vs.36.4%).When comparing the distribution of other diagnoses during hospitalization in the Cardiology Department,the proportion of patients with only one other diagnosis was higher in the first visit group of Neurology Department compared to those with two or more diagnoses,which was statistically significant(x2=9.3,P=0.03).There was no statistical difference in hospitalization days between the two departments(X^(2)=2.2,P=0.14).Although there was a significant difference in patient outcomes,with a lower proportion of patients not recovering or dying in the Neurology Department(x2=4.6,P=0.03),there was no significant difference in the interval between hospitalizations for the two groups(180 d,X^(2)=0.1,P=0.72;90 d,X²=1.8,P=0.18).Conclusions The need for early prevention,diagnosis,and treatment of patients with both cardiovascular and cerebrovascular diseases is still a pressing concern.Exploring a combined diagnosis and treatment model for multiple diseases may prove useful in overcoming the limitations of the current single disease diagnosis and treatment approach.