12 744例院前急救患者流行病学特点分析

目的调查怀化市院前急救患者流行病学情况，探讨该地区院前急救特点，以指导本地区院前急救医疗体系的完善和建设。 方法从怀化市急救中心系统数据库中导出2013年9月21日至2016年9月20日有完整记录的12 744例院前急救患者资料进行回顾性统计分析，其中男性7033例，女性5711例，年龄为1个月～ 94岁，平均年龄(51.8±22.6)岁。具体分析不同治疗结局院前急救非死亡、院前急救死亡(进一步细分为院前急救心脏性死亡和院前急救非心脏性死亡)]患者接受院前急救的调度时间、到达时间、现场时间、返回时间、出车总时间、急救半径、季度性分布、疾病类型、性别与年龄分布情况；分析不同疾病类型的院前急救患者的年龄分布情况。 结果(1)院前死亡组患者接受院前急救的到达时间、返回时间、急救半径明显小于院前非死亡组，前组的现场时间、出车总时间均大于院前非死亡组(P<0.01或P<0.05)；院前心脏性猝死组患者接受院前急救的调度时间与院前非心脏性猝死组的差异无统计学意义(P>0.05)，但到达时间、返回时间、出差总时间和急救半径大于院前急救非心脏性猝死组，且现场时间明显小于院前急救非心脏性猝死组(P<0.01或P<0.05)。(2)院前急救组、院前非死亡组、院前死亡组、院前非心脏性猝死组及院前心脏性猝死组的病例数均以第1季度为最多。(3)在12744例院前急救患者中，创伤类居首位，占32.99%(4 204/12 744)，且以21～50岁最多(其中交通事故又是创伤类最常见的原因)；同为高发疾病的循环系统、神经系统、消化系统、呼吸系统类则以≥51岁的中老年患者最多，中毒类以21～50岁的青壮年患者最多(其中急性酒精中毒是中毒类最常见的原因，占中毒类的76.52%)。(4)在657例院前急救死亡患者中，创伤、中毒类的死亡分别居第一、五位，均以21～50岁最多；循环系统、神经系统、呼吸系统、消化系统类疾病分别居第二、三、四、六位，均以≥51岁中老年患者为最多；进一步分析发生心脏性猝死的院前急救患者又以循环系统类疾病为最多的。(5)男性院前急救总例数、总死亡例数及院前心脏性猝死例数均明显高于女性。(6)院前急救死亡患者数占院前急救总例数的5.16%(657/12 744)；其中院前心脏性猝死占院前急救总例数的1.11%(141/12 744)，占院前死亡患者数的21.46%(141/657)。 结论创伤，尤其是交通意外伤，是近年怀化市院前急救和致死的主要原因，且多见于青壮年患者；心脑血管疾病则是中老年患者院前急救和致死的主要疾病类型。加强急救网络建设、合理配制急救调度点设置，对存在心脏性猝死证据或危险因素的患者提高警惕，针对特定时节、病种和人群制定预防和应对预案，促进院前急救知识和技能群众化普及，注重心脑血管病和呼吸系统疾病防治，提高群众对常见急危重症的早期识别能力等针对性举措，都将有利于降低该地区院前急救的发生率、死亡率，改善患者预后。

Epidemiological study of 12 744 cases in pre-hospital emergency care in huaihua city

ObjectiveTo guide the improvement and construction of Emergency Medical Service System, and investigate the epidemiological information of patients in pre-hospital emergency care in Huaihua city and probe the patients, characteristic. MethodsThe data were exported from the computer databases of Huaihua city, emergency medical center between 9-21, 2013 and 9-20, 2016.The thorough records of data from 12 744 aid patients were conducted to statistical analysis.The 7 033 male and 5 711 female between 1 month to 94 years old in that, the average ages is 51.8±22.6 . Specificly analyse different results of treatment Pre-hospital care non-death, pre-hospital death (Pre-hospital cardiac death and Pre-hospital non-cardiac death)], that patients accepted pre-hospital emergency care of the time of deployment, arrival, spot, returning, drawing-out, and rescuing radius, quarterly distribution, types of diseases, the distribution of sexs and ages; this analyses the situation of ages of the different types of diseases about Pre-hospital medical care patients. Results(1) The scheduling time, running time, returning time and service radius about patients receiving pre-hospital care in the death group were less than those of the non-death group, and the rescue time and total time of the former were more than those of the latter respectively (P<0.01 or P<0.05). The scheduling time of Patients receiving pre-hospital care didn’t have significant difference between the sudden cardiac death groups and the non- sudden cardiac death groups respectively(P>0.05), but running time, returning time, total time and service radius of the sudden cardiac death groups were more than those of the non- sudden cardiac death groups, and returning time of the former was less than that of Pre-hospital care group of non-sudden cardiac death (P<0.01 or P<0.05). (2)The patients, amount in Pre-hospital medical care group, the non-death group, the death group, the non- sudden cardiac death group and the sudden cardiac death group were common in the first season of the year. (3)In 12 744 cases of pre-hospital medical care patients group, the patients, amount of trauma was at most, the percentage of the trauma group to the pre-hospital medical care group was 32.99%(4 204/12 744), whose age grades was by far among 21~50, which the patients, amount of traffic accident was at the most, and the others with a high incidence of the disease in sequence were circulatory system, nervous system, digestive system, poisoning group and respiratory system, whose age grades in circulatory system, nervous system, digestive system, respiratory system was by far above 51, the patients, age grades in poisoning group was patients by far among 21~50, which the patients, amount of acute alcoholism was at the most, the percentage of the acute alcoholism group to the poisoning group was 76.52%. (4)In 657 cases of aid death patients group, the death amount of trauma and poisoning group ranked at the 1th, 5th respectively, whose age grades was by far among 21~50.The death amount of diseases of circulatory system, nervous system, respiratory system and digestive system ranked at the 2th, 3th, 4th, 6th respectively, those patient’ age grades was by far above 51, in the further analysis, the amount of patients with pre-hospital of sudden cardiac death was at most in the death amount of diseases in circulatory system.(5) The total amount, the death amount and the sudden cardiac death amount of cases of male patients were more than those of female patients. (6) The percentage of the death group to the pre-hospital medical care group cases was 5.15%(657/12 744), and the percentage of the sudden cardiac death group to the pre-hospital medical care group cases was 1.11%(141/12 744), and the percentage of the sudden cardiac death patients group to the death group was 21.46%(141/657). ConclusionsTrauma, especially in traffic accident injury, is the main cause of death of pre-hospital care in Huaihua city in recent years. The measures benefit to reduce icidence, mrtality in pre-hospital emergency medical care in the local aera by strengthening emergency first aid network construction, the rational preparation schedule settings, or the evidence for the existence of sudden cardiac death risk factors in patients with increased vigilance, making preventions plans for a particular season, disease and people, promoting the knowledge and skills of pre-hospital popularity, focusiong on cardio-cerebral vascular disease and respiratory disease prevention and control, improving the masses of the common early identification of critical capacity and other targeted initiatives.