摘要
目的探讨急诊科65岁以上就诊患者多病共存发生率及其对住院死亡风险的影响,为降低65岁以上多病共存患者住院死亡风险提供理论依据。方法以2019年1月至2020年1月期间西安医学院第一附属医院急诊接诊的65岁以上的老年患者为对象,分析其多病共存情况;收集多病共存患者现患疾病信息以及血压、血糖水平和其他潜在影响因素等信息,以及急诊后住院的发生情况,并分析讨论住院死亡风险的影响因素情况。结果研究期间65岁以上患者共1195例,其中多病共存者(排除恶性肿瘤)469例,发生率为39.25%。急诊老年患者中多病共存的具体疾病种类占比占前四位的疾病如下:缺血性脑卒中(43.92%)、急性心肌梗塞(24.95%)、出血性脑卒中(16.84%)、和跌倒(11.30%)。此外,多病共存病种组合中以“缺血性脑卒中+高血压+糖尿病+心律失常”所占构成比例最高(42.22%),其次为“心肌梗塞+缺血性脑卒中+高血压+糖尿病+心律失常”(21.11%),构成比排序第三位为“跌倒+缺血性脑卒中+高血压+糖尿病+心律失常”(0.66%)。469例多病共存患者中急诊后住院期间死亡者共计68例;将469例患者分成死亡者和存活者两组,分析影响死亡风险的潜在因素,多因素回归分析结果提示,男性(OR=1.485,P<0.001)、年龄超过80岁(OR=3.090,P<0.05)、共病种类超过四种(OR=4.407,P<0.001)、BMI水平显示消瘦(OR=4.366,P<0.001)以及共病种类中包含高血压(OR=3.564,P<0.001)为潜在危险因素,会增加死亡风险;而血压水平正常(OR=0.581,P<0.001)可能具有潜在的减低死亡风险的作用。结论对急诊接诊65岁以上老年患者人群中的男性、年龄超过80岁、消瘦以及共病种类多(超过四种),特别是同时罹患高血压的患者应给予特别关注,以减低急诊后住院治疗期间死亡风险。
Objective To investigate the incidence of multiple disease coexistence in emergency department patients over 65 years old and its impact on the risk of death in hospital,so as to provide theoretical basis for reducing the risk of death in emergency department patients over 65 years old.Methods From January 2019 to January 2020,elderly patients over 65 years old who received emergency treatment in our hospital were selected as subjects to analyze the coexistence of multiple diseases.The information of current disease,blood pressure,blood glucose level and other potential influencing factors,as well as the incidence of hospitalization after emergency treatment were collected,and the factors influencing the risk of death in hospital were analyzed and discussed.Results During the study period,there were 1195 patients over 65 years old,including 469 patients with multi-disease coexistence(excluding malignant tumors),with an incidence rate of 39.25%.Among the elderly patients in the emergency department,the top four diseases with multiple coexisting diseases are as follows:ischemic stroke(43.92%),acute myocardial infarction(24.95%),hemorrhagic stroke(16.84%),and falls(11.30%).In addition,"ischemic stroke+hypertension+diabetes+Cardiac arrhythmias"accounted for the highest proportion(42.22%)in the combination of multi-disease coexisting diseases,followed by"myocardial infarction+ischemic stroke+hypertension+Diabetes+Cardiac arrhythmias"(21.11%),and the third in the composition ratio was"fall+ischemic stroke+hypertension+diabetes+Cardiac arrhythmias"(0.66%).Among the 469 patients with multi-disease coexistence,a total of 68 died during hospitalization after emergency department;469 patients were divided into two groups:the dead and the survivors,and the potential factors affecting the risk of death were analyzed.The multivariate regression analysis showed that male(OR=1.485,P<0.001),age over 80 years(OR=3.090,P<0.05),more than four types of comorbidities(OR=4.407,P<0.001),BMI level showed weight loss(OR=4.366,P<0.001)and
作者
李朝杰
尚鑫
LI Zhaojie;SHANG Xin(Department of Emergency,the First Affiliated Hospital of Xi′an Medical University,Xi′an,Shaanxi 710077,China;Department of Emergency,Xi′an Central Hospital,Xi′an,Shaanxi 710004,China)
出处
《公共卫生与预防医学》
2023年第2期109-112,共4页
Journal of Public Health and Preventive Medicine
基金
陕西省科技计划项目(2023-YBSF-599)。
关键词
65岁以上患者
急诊
多病共存
死亡风险
回归分析
Over 65 years old
Emergency department
Coexistence of multiple diseases
Death risk
Regression analysis
