摘要
目的收集首都医科大学附属复兴医院老年共病住院患者的临床资料,分析其临床特征,为临床针对此类患者的医疗工作提供理论依据。方法选取2016-04-01至2017-03-31在首都医科大学附属复兴医院综合科住院的符合纳入标准的老年共病患者为研究对象。收集住院患者的病历资料。统计患者各种慢性病患病情况及其累及系统情况。比较不同性别和≥80岁、<80岁患者各种慢性病患病率。统计患者入院原因、感染发生率及感染部位。分别比较不同性别和<80岁、≥80岁患者感染发生率。比较发生感染和未发生感染患者住院期间各种急性并发症发生率及住院天数、住院日均费用。结果共纳入年龄≥60岁的非重复住院共病患者761例;男465例,女296例;<80岁患者125例,≥80岁患者636例。老年共病住院患者患慢性病数量为2~16个,其中31.4%(239/761)的患者患9种慢性病,19.3%(147/761)的患者患11种慢性病,18.0%(137/761)的患者患8种慢性病。老年共病住院患者慢性病累及系统数量为2~9个,其中27.9%(212/761)的患者累及5个系统,25.9%(197/761)的患者累及6个系统,12.2%(93/761)的患者累及4个系统。老年共病住院患者各种慢性病患病情况:74.9%(562/761)患高血压,73.9%(561/761)患高脂血症,66.8%(505/761)患脑梗死,48.1%(366/761)患冠心病,38.1%(290/761)患糖尿病。不同性别患者神经系统疾病中脑梗死和其他、呼吸系统疾病中慢性阻塞性肺疾病、泌尿系统疾病中前列腺增生、肌肉骨骼系统疾病中其他患病率比较,差异有统计学意义(P<0.05)。≥80岁患者冠心病、慢性心力衰竭、心律失常、消化性溃疡患病率高于<80岁患者(P<0.05)。18.7%(142/761)老年共病住院患者患有系统肿瘤,其中以消化系统肿瘤为主。41.3%(314/761)的患者由于急性感染入院。46.5%(354/761)的患者发生感染(40例为院内获得性感染),其中肺部感染占82.8%(293/354)。≥80岁患者感染发生率高于<80岁患者(P=0.001)。发生感染患者住院期间消化道出血、低蛋白血症、贫血加重、电解质紊乱、肝功能受损、胃肠功能紊乱、压疮、呼吸衰竭、急性心力衰竭发生率及住院日均费用高于未发生感染患者(P<0.05)。结论老年共病患者多数患9种慢性病,累及4~6个系统,以高血压、高脂血症、脑梗死、冠心病、糖尿病等慢性病多发,且将近半数老年共病患者易发生感染,疾病负担较大。因此,临床医师针对老年共病患者应进行个体化的治疗。
Objective To analyze the clinical characteristics of elderly inpatients with multimorbidity from Geriatric Department,Fuxing Hospital,Capital Medical University based on the collected medical records,providing theoretical evidence for the diagnosis and treatment of such patients.Methods The enrolled elderly inpatients with multimorbidity were from Geriatric Department,Fuxing Hospital,Capital Medical University from April 1 st,2016 to March 31 st,2017.Based on the reviewing of their medical records,we analyzed the prevalence of chronic diseases and the involved systems,summarized the causes of hospitalization,incidence of infection and site of infection,and compared the prevalence of chronic diseases and incidence of infections by sex and age group（ ≥ 80 age group and 80 age group）.Moreover,the incidence of in-hospital acute complications,length of stay（LOS） and mean hospital costs per day between patients with infections during hospitalization and those without were compared.Results 761 inpatients（465 males and 296 females） aged 60 or over（125 patients 80 years old,and 636 patients ≥ 80 years old） with multimorbidity and non-repetitive hospitalization history were analyzed.The number of chronic diseases in the inpatients ranged from 2 to 16.31.4%（239/761）,19.3%（147/761）and 18.0%（137/761）had 9,11,8 chronic diseases,respectively.The number of systems involved by chronic diseases was 2-9 generally,in particular,the number of involved systems of 27.9%（212/761）,25.9%（197/761） and 12.2%（93/761） of the patients was 5,6,4,respectively.With regard to the prevalence of chronic diseases,74.9%（562/761）were found with hypertension,73.9%（561/761）with hyperlipidemia,66.8%（505/761） with cerebral infarction,48.1%（366/761） with coronary heart disease and 38.1%（290/761） with diabetes.Sex was not significantly associated with the prevalence of cerebral infarction and other nervous system diseases except cerebral infarction,neuropathy,dementia,and sequelae of cerebral hemorrhage,prevalence of chronic obstructive pulmonary disease,prevalence of prostatic hyperplasia,and prevalence of musculoskeletal system diseases except osteoarthropathy,osteoporosis and cervical/lumbar disease（P〈0.05）.Compared with those aged less than 80 years,patients aged 80 or over had much higher prevalence of coronary heart disease,chronic heart failure,arrhythmia,and peptic ulcer（P〈0.05）.Systemic neoplasms（most were gastrointestinal neoplasms） were identified in 18.7%（142/761）of the inpatients.In terms of the causes for hospitalization,41.3%（314/761） were due to acute infection.Of the 46.5%（354/761） had infections,40 were found with hospital-acquired infections,and 82.8%（293/354） with pulmonary infection.Patients aged less than 80 years had much lower incidence of infections compared with those aged 80 or over（P=0.001）.Compared with those with infections,those without infections demonstrated much lower incidences of gastrointestinal hemorrhage,hypoproteinemia,anemia exacerbation,electrolyte disorder,impaired liver function,gastrointestinal dysfunction,pressure sore,respiratory failure,acute heart failure and lower mean hospital costs per day（P〈0.05）.Conclusion The majority of the elderly inpatients have 9 chronic diseases,and most of which are hypertension,hyperlipidemia,cerebral infarction,coronary heart disease and diabetes,involving 4-6 systems.Nearly half of these patients are prone to infections,which causes great economic burden.In view of this,individualized treatment is suggested for this population.
作者
闫巍
李瑞
王杰萍
张洪波
吴薇
王斐
张洁
张新焕
朱钟慧
杜雪平
YAN Wei;LI Rui;WANG Jie-ping;ZHANG Hong-bo;WU Wei;WANG Fei;ZHANG Jie;ZHANG Xin-huan;ZHU Zhong-hui;DU Xue-ping(Department of General Practice,Fuxing Hospital,Capital Medical University,Beijing 100038,China;Department of Nephrology,Beijing First Hospital of Integrated Chinese and Western Medicine,Beijing 100026,China;Geriatric Department,Fuxing Hospital,Capital Medical University,Beijing 100038,China;School of Public Health,Capital Medical University,Beijing 100069,China;Beijing Key Laboratory of Environmental Toxicology,Capital Medical University,Beijing 100069,China;Yuetan Community Health Service Center of Fuxing Hospital,Capital Medical University,Beijing 100038,China)
出处
《中国全科医学》
CAS
北大核心
2018年第14期1648-1656,共9页
Chinese General Practice
基金
首都医科大学基础-临床科研合作基金(16JL59)
