2009-2023年天津市某儿童医院住院儿童死亡病例分析

Analysis of death cases of hospitalized children in a pediatric hospital in Tianjin from 2009 to 2023

目的分析2009—2023年天津市某儿科医院住院儿童死亡病例特点。方法收集天津市某儿童医院2009—2023年住院儿童的病案首页信息,分析2009—2013年、2014—2018年、2019—2023年三个时间段死亡病例的性别、年龄、疾病系统及死亡病种情况。结果2009—2023年,住院患儿共678145例,其中876例死亡,死亡率为0.13%;三个时间段的死亡率分别为0.28%、0.16%、0.06%,整体呈递减趋势(χ^(2)=383.962,P<0.01)。男性儿童死亡率(0.12%)显著低于女性儿童死亡率(0.15%)(χ^(2)=303.785,P<0.01)。婴儿期死亡人数最多(263例),青春期死亡人数最少(61例)。死亡疾病系统顺位在三个时间段的变化方面,循环系统疾病从第六位上升至第三位,肿瘤从第九位上升至第六位,先天性畸形、变形和染色体异常从第三位降至第八位。前十位死亡病种中,重症肺炎在三个时间段中均排名第一;急性淋巴细胞白血病顺位由2009—2013年的第九位上升至2019—2023年的第三位。新生儿期排名第一的死亡病种为新生儿呼吸衰竭,婴儿期、幼儿期、学龄前期及学龄期排名第一的死亡病种均为重症肺炎,青春期排名第一的死亡病种为海绵窦脓肿。结论2009—2023年间天津市住院儿童死亡率明显下降,儿科临床和预防工作应继续重点关注婴儿期的重症肺炎、脓毒血症患儿,以及海绵窦脓肿等病种,同时应加强对循环系统、某些传染病和寄生虫病、意外伤害、恶性肿瘤的预防和控制,以有效降低住院患儿死亡率。

Objective To analyze the characteristics of mortality cases of hospitalized children in a pediatric hospital in Tianjin from 2009 to2023.Methods Medical records of hospitalized children in a pediatric hospital in Tianjin from 2009 to 2023 were collected and the gender,age,disease system,and type of death disease from 2009 to 2013,2014 to 2018,and 2019 to 2023 were analyzed.Results From 2009 to 2023,there were 678145 hospitalized children,of whom 876 died,the mortality rate was 0.13%.And the mortality rates for the three time periods were 0.28%,0.16%,and 0.06%,respectively,showing a decreasing trend(χ^(2)=383.962,P<0.01).The mortality rate of male children(0.12%)was significantly lower than that of female children(0.15%)(χ^(2)=303.785,P<0.01).The highest number of deaths occurred during infancy(263 cases),and the lowest number occurred during adolescence(61 cases).In the changes of the order of death disease system over three periods,circulatory system diseases rose from sixth place to third place;tumors rose from ninth place to sixth place,and congenital malformations,deformities,and chromosomal abnormalities decreased from third place to eighth place.Among the top ten deadly diseases,severe pneumonia ranked first in all three periods;acute lymphoblastic leukemia increased from ninth place in 2009-2013 to third place in 2019-2023.The leading cause of death during the neonatal period was neonatal respiratory failure,while the leading cause of death during infancy,early childhood,preschool,and school years was severe pneumonia.The leading cause of death during adolescence was cavernous sinus abscess.Conclusion The mortality rate of hospitalized children in Tianjin has decreased from 2009 to 2023.Clinical and preventive work in pediatrics should continue to focus on critically ill children with severe pneumonia sepsis,as well as diseases such as cavernous sinus abscesses.At the same time,efforts should be made to strengthen the prevention and control of the circulatory system,certain infectious and parasitic diseases,accidental injuries,and malignant tumors,to reduce the mortality rate of hospitalized children.