新型冠状病毒感染疫情对河北省某三甲医院心血管疾病住院量及疾病谱影响

The influence of COVID-19 on the number of cardiovascular disease inpatients and disease spectrum in a tertiary hospital in Hebei Province

目的探讨2019—2021年河北省某三甲医院心血管疾病住院量及疾病谱的变化趋势,分析新型冠状病毒感染对心血管疾病亚型构成比影响,为医疗资源合理配置提供参考。方法收集2019年1月1日—2021年12月31日该院心脏中心住院患者病案首页数据,根据国际疾病分类(International Classification of Diseases,ICD)第十次版本(ICD-10)分类,分析其疾病谱特征。结果2019—2021年该院心血管疾病患者住院共计7698例,疾病顺位基本无变化,冠心病构成及顺位始终位居首位,先天性心脏病、心脏瓣膜病构成比逐年降低(χ^(2)=218.189,P<0.01)。与2019年同期相比,2020年2月住院量减少,3月反弹式增加,直至6月趋于稳定,2021年1—3月逐月递增(χ^(2)=117.878,P<0.01)。新型冠状病毒感染期间心绞痛占心血管疾病患者入院总数的构成比骤降,心肌梗死构成比反超心绞痛,先天性心脏病构成比呈波动性下降。结论心肌梗死等心血管急症入院患者构成比增长,先天性心脏病等隐匿性心血管疾病入院患者构成比显著减少,提示疫情下医院需更加重视经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)绿色通道管理,开通互联网就诊及药物物流配送,同时根据风险分层进行个性化先天性心脏病筛查工作。

Objective To explore the time trend in the number of inpatients of cardiovascular diseases(CVD)and the disease spectrum in a tertiary hospital from 2019 to 2021,and to further analyze the impact of COVID-19 on the proportions of each disease within the CVD group,so as to inform rational allocation of medical resources.Methods The information on the first page of inpatients medical records in the heart center of the study hospital from January 1,2019 to December 31,2021 were collected,and the disease spectrum was analyzed according to International Classification of Diseases(ICD)-10.Results A total of 7698 CVD patients were admitted in the period from 2019 to 2021.The order of diseases in frequency was basically unchanged,with coronary artery disease(CAD)continuing to be the most common among CVD,while the proportions of congenital heart disease(CHD)and heart valve disease(HVD)decreased year by year(χ^(2)=218.189,P<0.01).Compared with the same period in 2019,the number of hospitalizations decreased in February 2020,rebounded since March until stabilizing in June 2020,then increased month by month from January to March 2021(χ^(2)=117.878,P<0.01).During the COVID-19 pandemic,the proportion of angina among all CVD admissions decreased sharply,while the proportion of myocardial infarction exceeded that of angina pectoris,and the proportion of CHD fluctuated downwards.Conclusions The proportion of cardiovascular emergencies such as myocardial infarction increased during COVID-19,while the proportion of latent cardiovascular diseases such as CHD decreased significantly.It suggests that hospitals should pay more attention to the management of fast-track percutaneous coronary intervention for cardiovascular emergencies under epidemics,the establishment of a system for on-line consultation and drugs delivery,patients'psychological health,and personalized CHD screening following risk stratification.