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目的通过回顾性分析解放军总医院呼吸科监护室1495例住院患者中253例死亡特点、不同影响因素死亡风险及死亡时间规律,寻找工作弱点,以期提高工作质量,降低死亡率。方法从医院信息系统(HIS)中提取住院患者资料,按照不同时间划分方法进行分类统计。结果每年11月至次年3月死亡率高于其他月份,为19.5%(P<0.05)。8∶01~9∶00及23∶01~24∶00入院死亡率高(P<0.05),分别为41.7%和50.0%。周内各天死亡率差异有统计学意义(P<0.01),周六死亡率最高,为43.1%。0∶01~1∶00、4∶01~5∶00、9∶01~10∶00、13∶01~14∶00死亡构成比较大(P<0.05),分别为7.1%、7.1%、6.7%、6.7%。非工作日死亡率(38.3%)高于工作日死亡率13.2%(P<0.01)。非工作时间死亡率(31.3%)高于工作时间(工作日8∶00~11∶30,14∶30~18∶00)死亡率(5.2%,P<0.01)。Logistic回归分析提示,年龄、入院月份、出院时间是否为工作时间对预后的影响差异有统计学意义(P<0.05),OR值分别为1.06、1.07、0.08。结论每年11月至次年3月死亡率高,与冬季呼吸系统疾病高发,寒冷天气使得机体循环阻力增大,调节失衡及大气污染相关。年龄因素、入院月份、出院时间是否在工作时间与预后相关。死亡率与医护人员工作结构明显相关,因此,提高医护人员工作质量,合理安排医护力量,对于改善患者预后,降低死亡率有很大作用。
Objective To retrospectively analyze the characteristics of 253 deaths among 1495 inpatients in Department of Respiratory Care, General Hospital of the People’s Liberation Army General Hospital, and to find out the work weaknesses in order to improve the quality of work and reduce the mortality rate. Methods Inpatient data were extracted from hospital information system (HIS), and classified according to different time categories. Results The mortality rate from November to March of each year was 19.5% higher than that of other months (P <0.05). 8:01 ~ 9:00 and 23:01 ~ 24:00 high mortality rate (P <0.05), respectively, 41.7% and 50.0%. There was a statistically significant difference in the daily mortality rates between the two groups (P <0.01). The highest death rate was on Saturday (43.1%). 0:01 to 1:00, 4:01 to 5:00, 9:01 to 10:00, and 13:01 to 14:00 (P <0.05), accounting for 7.1%, 7.1%, 6.7% %, 6.7%. The non-working day mortality rate (38.3%) was higher than the working day mortality rate of 13.2% (P <0.01). The non-working time mortality rate (31.3%) was higher than the working time (8: 00-11: 30-14:30-18: 00 working days) (5.2%, P <0.01). Logistic regression analysis showed that there was significant difference in the effect of working time on the prognosis between the age, admission month and discharge time (P <0.05). The OR values were 1.06, 1.07 and 0.08 respectively. Conclusion The mortality rate is high from November to March of each year, which is related to the high incidence of respiratory diseases in winter and cold weather, which leads to the increase of circulatory resistance, unbalanced regulation and air pollution. Age, admission month, and discharge time are related to the prognosis during working hours. The mortality rate is obviously related to the working structure of medical staff. Therefore, improving the quality of medical staff and rational arrangement of medical and health care power plays a significant role in improving patient prognosis and reducing mortality.