南京某儿童医院急诊患儿的疾病谱和转归分析

发布时间：2018-10-23 17:23

【摘要】：目的：通过分析急诊患儿的疾病谱与转归特点,为临床医务人员与卫生政策部门疾病防治、医疗卫生资源配置等提供重要参考资料。方法：采用回顾性分析方法收集南京某儿童医院急诊科2011-2013年间收集的17646例急诊患儿的电子病案,应用SPSS19.0软件对就诊患儿的人口学特征、就诊特点、疾病谱分布、转归结局以及患儿血糖的特征分布进行统计分析。结果：(1)17646名患儿中,男孩明显多于女孩,两者比例为1.78：1,婴儿最多(48.1%)；急诊时间以1-4月较为集中,占了全年的近一半。(2)急诊疾病谱构成中,呼吸系统疾病和神经系统疾病位居前两位,分别占34.0%和29.0%；呼吸系统疾病构成中以肺炎最多(36.4%),神经系统以抽搐待查为主(76.9%)。不同年龄段患儿的疾病病种有不同特点,新生儿和婴儿年龄患儿组,肺炎居首位(分别为70.6%和40.8%)；幼儿及以上年龄患儿组急性上呼吸道感染非常突出；新生儿组则呈现了自身特点,位列前3位的为心肺复苏术(79.4%)、婴儿猝死综合症(11.8%)和呼吸窘迫综合症(5.9%)。(3)17646例急诊患儿中,住院者总计14821例(占84.0%)、出院者总计1786例(10.1%)、死亡者总计200例(其中婴儿比例最高(42.5%),新生儿总计73例(36.5%))；在患儿进行危重情况急救处理中,经心肺复苏术处理的患儿死亡率达45.5%。(4)不同性别和年龄段下,异常血糖值间(低血糖/高血糖/糖尿病)具有统计学差异(P0.01)；呼吸系统疾病患儿血糖显著低于神经系统疾病血糖(P0.01)；低血糖/高血糖/糖尿病组,婴儿比例较高,分别为58.6%、43.6%、43.0%,急诊婴儿、幼儿、儿童组,糖尿病比例较高,新生儿组的低血糖比例较高,少年组的高血糖比例较高。不同转归组,血糖分布具有统计学差异(P0.01),出院组高血糖/糖尿病比例高,死亡组低血糖/高血糖比例高。结论：本研究直观反映该医院急诊患儿疾病谱和转归呈现的一定规律,急诊患儿存在性别差异,疾病分布与年龄有关,就诊时间呈现明显的季节性；新生儿死亡比例最高,死亡前心肺复苏术比例最高,因此正确及时的心肺复苏尤为关键,需要在全社会普及急救知识,为患儿的康复赢得时间；血糖水平与患儿发病存在关联,建议其工作重点应该放在对患儿常见病和多发病的防治上,并提示应多关注入院患儿的血糖值；同时关注儿童心理健康,对家长、老师和儿童提供适宜的健康教育以及及时的后期追踪随访。
[Abstract]:Objective: to provide important references for the prevention and treatment of diseases and the allocation of medical and health resources for clinical medical staff and health policy departments by analyzing the disease spectrum and outcome characteristics of children in emergency department. Methods: the electronic medical records of 17646 children in emergency department of a children's hospital in Nanjing from 2011 to 2013 were collected by retrospective analysis. The demographic characteristics, the characteristics and the distribution of disease spectrum of the children were analyzed by SPSS19.0 software. The outcome and the distribution of blood glucose in children were analyzed statistically. Results: (1) among the 17646 children, there were more boys than girls (1.78: 1), the infants were the most (48.1%), the emergency time was concentrated in January and April, which accounted for nearly half of the whole year. (2) the composition of emergency disease spectrum, Respiratory diseases and nervous system diseases ranked the first two places, accounting for 34.0% and 29.0% respectively, pneumonia was the most common disease (36.4%) and convulsion was the main nervous system (76.9%). The disease types of children of different ages have different characteristics. Pneumonia is the first in newborn and infant age group (70.6% and 40.8% respectively), acute upper respiratory tract infection is very prominent in infants and over age group. The neonatal group showed its own characteristics, including cardiopulmonary resuscitation (79.4%), sudden infant death syndrome (11.8%) and respiratory distress syndrome (5.9%). (3). 14821 cases (84.0%) were hospitalized, 1786 cases (10.1%) were discharged, 200 cases were dead (42.5%), 73 cases (36.5%) of neonates were treated with emergency treatment in critical condition. The mortality rate of children treated with cardiopulmonary resuscitation was 45.5. (4) there were significant differences in abnormal blood glucose (hypoglycemia / hyperglycemia / diabetes) between different sexes and age groups (P0.01). The proportion of infants with hypoglycemia / hyperglycemia / diabetes mellitus was higher, which was 58.6% and 43.6%, respectively, and the proportion of emergency infants, children with diabetes mellitus was higher than that of patients with respiratory diseases (P0.01), and the proportion of infants with hypoglycemia / hyperglycemia / diabetes mellitus was higher than that of infants with acute respiratory diseases (P 0.01). The proportion of hypoglycemia was higher in neonate group and higher in juvenile group. The distribution of blood sugar in different groups was statistically different (P0.01). The ratio of hyperglycemia / diabetes was high in discharge group and high in death group. Conclusion: this study intuitively reflects the regularity of disease spectrum and outcome of emergency children in this hospital. There are sex differences in emergency children, the distribution of diseases is related to age, the visiting time is obviously seasonal, the proportion of neonatal death is the highest. The proportion of cardiopulmonary resuscitation before death is the highest, so correct and timely CPR is particularly critical. It is necessary to popularize the knowledge of first aid in the whole society to buy time for the recovery of children. It is suggested that the focus of its work should be on the prevention and treatment of common and frequently-occurring diseases in children, and that more attention should be paid to the blood sugar values of hospitalized children, and to the mental health of children, and to parents. Teachers and children provide appropriate health education and timely follow-up.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R720.597

【参考文献】