遵义地区某三甲医院近5年院前急救接诊死亡病例的特征分析

Analysis of the characteristics of recent 5-year death cases in a class A tertiary hospital in Zunyi area

目的回顾性分析遵义医科大学附属医院近5年院前急救接诊死亡病例的流行病学特征,为遵义地区院前急救科学化管理提供依据,为降低院前死亡率制定针对性防控策略提供参考。方法调查遵义医科大学附属医院急救中心2017年1月—2021年12月救护车出诊的死亡病历资料,统计分析死亡病例的一般资料、死亡原因、死亡地点、呼救时间及出车时间等。结果近5年救护车接诊死亡病例437例,男女性别比例1.95∶1,>55岁患者占比66.5%,其中56~65岁患者占比最高(28.1%)。按病因分布,≤45岁患者的病因排序前2位是猝死及不明原因(45.3%)、创伤(30.7%),>45岁患者的病因排序前2位是心脑血管疾病(41.7%)、猝死及不明原因(32.6%),两组患者的病因构成差异有统计学意义(P<0.05)。按呼救时间分布,冬春季233例(53.3%),夏秋季204例(46.7%),呼救高峰月份在9月(43例,9.8%),1天中最高峰时段08∶00-09∶59,其次14∶00-15∶59,最低峰时段00∶00-01∶59,其次04∶00-05∶59。按发生地点分布,68.4%死亡病例发生在家中,但仅有0.7%第一目击者实施急救。2021年急救反应时间10.00(8.00,15.00)min、现场救治时间17.00(13.75,30.00)min、急救任务完成时间37.50(29.75,48.00)min较前相比明显缩短(P<0.05)。结论遵义地区院前死亡病例,冬春季多于夏秋季,男性多于女性,中老年人群占比最大,不同年龄段人群的死亡原因有差异,死亡地点以家中居多,但合格的第一目击者严重匮乏,2021年救护车的各项出车时间明显缩短。为降低院前死亡率,社会、医院、社区等多部门应联合开展针对性综合防控策略和预案。

Objective The epidemiological characteristics of recent 5-year pre-hospital death cases in Affiliated Hospital of Zunyi Medical University were analyzed retrospectively,which provided the basis for scientific management of pre-hospital emergency treatment,and provided reference for formulating targeted prevention and control strategies to reduce pre-hospital mortality.Methods The pre-hospital death cases’data were investigated from January 2017 to December 2021 in the emergency Center of Affiliated Hospital of Zunyi Medical University,and the general information,death causes,death place,call time and ambulance departure time were analyzed.Results In recent 5 years,there were 437 death cases received by ambulance,and the male to female ratio was 1.95∶1.Patients aged>55 accounted for 66.5%,and patients aged 56-65 accounted for the highest proportion(28.1%).According to etiology distribution,the top 2 causes of patients(≤45 years)group were sudden death and unknown cause(45.3%),trauma(30.7%),and top 2 causes of patients(>45 years)were cardiovascular and cerebrovascular diseases(41.7%),sudden death and unknown cause(32.6%).There was statistical difference of etiology composition between the two groups(P<0.05).According to call ti me distribution,233 cases(53.3%)were in winter and spring,204 cases(46.7%)in summer and autumn.The peak month of call was in September(43 cases,9.8%),and the peak time of the day was 08∶00-09∶59,followed by 14∶00-15∶59,the lowest peak period was 00∶00-01∶59,followed by 04∶00-05∶59.According to location distribution,68.4%of deaths occurred at home,but only 0.7%of first witnesses gave first aid.In 2021,first aid response time 10.00(8.00,15.00)min,on-site treatment time 17.00(13.75,30.00)min and task completion time 37.50(29.75,48.00)min were significantly shorter than before(P<0.05).Conclusion In Zunyi area,there were more pre-hospital deaths in winter and spring than in summer and autumn,more men than women,and the middle-aged and elderly people accounted for the largest proportion.The causes of death were different in different age groups.Most of the death places were at home,but qualified first responders were in serious shortage.In order to reduce the pre-hospital mortality,social,hospital,community and other departments should jointly carry out targeted comprehensive prevention and control strategies and plans.