【摘要】：目的：通過分析急診患兒的疾病譜與轉(zhuǎn)歸特點(diǎn),為臨床醫(yī)務(wù)人員與衛(wèi)生政策部門疾病防治、醫(yī)療衛(wèi)生資源配置等提供重要參考資料。方法：采用回顧性分析方法收集南京某兒童醫(yī)院急診科2011-2013年間收集的17646例急診患兒的電子病案,應(yīng)用SPSS19.0軟件對(duì)就診患兒的人口學(xué)特征、就診特點(diǎn)、疾病譜分布、轉(zhuǎn)歸結(jié)局以及患兒血糖的特征分布進(jìn)行統(tǒng)計(jì)分析。結(jié)果：(1)17646名患兒中,男孩明顯多于女孩,兩者比例為1.78：1,嬰兒最多(48.1%)；急診時(shí)間以1-4月較為集中,占了全年的近一半。(2)急診疾病譜構(gòu)成中,呼吸系統(tǒng)疾病和神經(jīng)系統(tǒng)疾病位居前兩位,分別占34.0%和29.0%；呼吸系統(tǒng)疾病構(gòu)成中以肺炎最多(36.4%),神經(jīng)系統(tǒng)以抽搐待查為主(76.9%)。不同年齡段患兒的疾病病種有不同特點(diǎn),新生兒和嬰兒年齡患兒組,肺炎居首位(分別為70.6%和40.8%)；幼兒及以上年齡患兒組急性上呼吸道感染非常突出；新生兒組則呈現(xiàn)了自身特點(diǎn),位列前3位的為心肺復(fù)蘇術(shù)(79.4%)、嬰兒猝死綜合癥(11.8%)和呼吸窘迫綜合癥(5.9%)。(3)17646例急診患兒中,住院者總計(jì)14821例(占84.0%)、出院者總計(jì)1786例(10.1%)、死亡者總計(jì)200例(其中嬰兒比例最高(42.5%),新生兒總計(jì)73例(36.5%))；在患兒進(jìn)行危重情況急救處理中,經(jīng)心肺復(fù)蘇術(shù)處理的患兒死亡率達(dá)45.5%。(4)不同性別和年齡段下,異常血糖值間(低血糖/高血糖/糖尿病)具有統(tǒng)計(jì)學(xué)差異(P0.01)；呼吸系統(tǒng)疾病患兒血糖顯著低于神經(jīng)系統(tǒng)疾病血糖(P0.01)；低血糖/高血糖/糖尿病組,嬰兒比例較高,分別為58.6%、43.6%、43.0%,急診嬰兒、幼兒、兒童組,糖尿病比例較高,新生兒組的低血糖比例較高,少年組的高血糖比例較高。不同轉(zhuǎn)歸組,血糖分布具有統(tǒng)計(jì)學(xué)差異(P0.01),出院組高血糖/糖尿病比例高,死亡組低血糖/高血糖比例高。結(jié)論：本研究直觀反映該醫(yī)院急診患兒疾病譜和轉(zhuǎn)歸呈現(xiàn)的一定規(guī)律,急診患兒存在性別差異,疾病分布與年齡有關(guān),就診時(shí)間呈現(xiàn)明顯的季節(jié)性；新生兒死亡比例最高,死亡前心肺復(fù)蘇術(shù)比例最高,因此正確及時(shí)的心肺復(fù)蘇尤為關(guān)鍵,需要在全社會(huì)普及急救知識(shí),為患兒的康復(fù)贏得時(shí)間；血糖水平與患兒發(fā)病存在關(guān)聯(lián),建議其工作重點(diǎn)應(yīng)該放在對(duì)患兒常見病和多發(fā)病的防治上,并提示應(yīng)多關(guān)注入院患兒的血糖值；同時(shí)關(guān)注兒童心理健康,對(duì)家長、老師和兒童提供適宜的健康教育以及及時(shí)的后期追蹤隨訪。
[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.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R720.597

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