我国八个大中城市院前急救流行病学调查分析

目的 调查我国大中城市院前急救患者流行病学情况,探讨院前急救病例特点.方法 从我国8个大中城市急救中心系统数据库中导出2008年度全部数据,就其有完整记录的资料进行统计分析.结果 (1)院前急救组调度时间、到达时间、现场时间、返回时间、出车总时间、急救半径分别为(2.16±1.10)min,(14.01±6.82)min,(12.12±5.96)min,(14.08±6.85)min,(42.34±20.21)min和(8.50±4.18)km,院前非死亡组分别为(2.19±1.13)min,(14.15±7.14)min,(11.60±6.72)min,(14.92±6.89)min,(41.86±19.53)min和(8.63±4.31)km,院前死亡组分别为(2.10±1.08)min,(13.68±7.14)min,(25.25±12.34)min,(13.75±6.48)min,(54.74±25.47)min和(7.86±3.91)km,院前非心脏性猝死组分别为(2.09±1.03)min,(13.58±6.78)min,(25.53±12.34)min,(13.60±6.54)min,(53.79±23.77)min和(7.67±3.86)km,院前心脏性猝死组分别为(2.12±1.02)min,(14.10±7.05)min,(24.79±12.08)min,(13.79±6.61)min,(54.80±25.36)min和(7.90±3.92)km.院前死亡组的调度时间、到达时间、返回时间、急救半径均明显小于院前非死亡组,前组的现场时间、出车总时间均明显大于后者(P＜0.05或P＜0.01).院前心脏性猝死组的调度时间、返回时间与院前非心脏性猝死组的差异无统计学意义(P＞0.05),但前组的到达时间、出车总时间、急救半径均明显大于后组,而现场时间明显小于后组(P＜0.05或P＜0.01).(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、院前心脏性猝死组的病例数均以第一季度为最多,其最少时间段分别是4:00-6:00、4:00-6:00、4:00-6:00、22:00-24:00、2:00-4:00,其最多时间段分别是20:00-22:00、20:00-22:00、8:00-10:00、2:00-4:00、8:00-10:00.(3)在241 876例院前急救病例中,创伤类患者是院前急救中最多的,年龄以21～50岁青壮年最多;其余依次是神经系统、循环系统、其他、消化系统、呼吸系统、中毒类,且神经系统、循环系统、呼吸系统类均以51岁(尤其是70岁)以上的中老年最多;其他、消化系统类均有两个高峰年龄段,其一是21～30岁青年阶段,其二是70岁以上的老年;中毒类以21～50岁青壮年最多,其中急性酒精中毒是最常见的病因.(4)在12 568例院前死亡病例中,循环系统、其他、呼吸系统、神经系统、消化系统类的死亡分别居第一、二、四、五、八位,均以51岁(尤其是70岁)以上的中老年最多,其中心脏性猝死又是循环系统类的死亡中最多的;创伤、中毒类的死亡分别居第三、六位,均以21～50岁青壮年最多.(5)男性患者院前急救的数量、总死亡量及院前心脏性猝死均明显高于女性.(6)院前死亡患者占院前急救的5.20%,院前心脏性猝死占院前急救的1.29%,院前心脏性猝死占院前死亡的24.87%,院前心脏性猝死占循环系统类死亡的67.33%.结论 (1)创伤与心脏性猝死已分别成为我国大中城市最常见的院前急救和致死原因.(2)加强心脑血管病和呼吸系统疾病防治,提高中老年患者的常见急危重症早期识别与院前急救水平对降低死亡率有重要意义.(3)加强安全生产、遵守交通法规、强化法制意识将是降低创伤,尤其是交通意外伤发生及其死亡的有力于段.

The epidemiological analysis of patients in pre-hospital medical care in large and medium-sized cities in China

Objective To investigate the epidemiological information of patients in pre-hospital medical care for our large and medium-sized cities and probe the patients' characteristic. Method The data in 2008 were exported from the computer databases of 8 large and medium-sized cities' emergency medical centers in our country.The thorough records of data were conducted to statistical analysis. Results ( 1 ) The scheduling time, running time, rescue time, returning time, total time and service radius in the pre-hospital medical care group were 2.16± 1.10(min), 14.01 ±6.82(min), 12.12±5.96(min), 14.08± 6.85(min), 42.34± 20.21(min)and 8.50±4.18(km), and the above parameter in the non-death group were 2.19 ± 1.13(min), 14.15 ± 7.14(min),11.60±6.72(min), 14.92 ±6.89(min), 41.86± 19.53(minutes) and 8.63±4.31(Km), and the above parameter in the death group were 2.10± 1.08(min), 13.68 ± 7.14(min), 25.25 ± 12.34(min), 13.75±6.48(min), 54.74 ± 25.47(min) and 7.86± 3.91(Km), and the above parameter in the non-sudden cardiac death group were2.09± 1.03(min), 13.58±6.78(min), 25.53± 12.34(min), 13.60± 6.54(min), 53.79±23.77(min) and 7.67 ± 3.86(Km), and the above parameter in the sudden cardiac death group were 2.12 ±1.02(min), 14.10±7.05(min), 24.79± 12.08(min), 13.79±6.61(min), 54. 80 ± 25. 36( min) and 7.90±3.92(Km) respectively. The scheduling time, running time, returning time and service radius in the death group were less than those of the non-death group, but the rescue time and total time of the former were more than those of the latter respectively ( P ＜ 0.05 or P ＜ 0. 001 ). The scheduling time and returning time didn' t have significant difference between the sudden cardiac death group and the non-sudden cardiac death group respectively ( P ＞ 0.05), but the running time, total time and service radius of the sudden cardiac death group were more than those of the non-sudden cardiac death group, and the rescue time of the former was less than that of the latter respectively ( P ＜ 0.05 or P ＜ 0.001 ). (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 at most in first quarter, and the least time slice of patients' amount were 4:00～ 6:00, 4:00～6:00, 4:00～ 6:00, 22:00～ 24:00, 2:00～4:00 respectively, and the most time slice of patients' amount were 20:00～ 22:00, 20:00～22:00, 8:00～ 10:00, 2:00 ～ 4:00, 8:00 ～ 10:00 respectively. (3)In 241 876 cases of pre-hospital medical care group, the patients' amount of trauma was at most, whose age grades was by far among21 ～50, and the others in sequence were nervous system, circulatory system, other group, digestive system, respiratory system and poisoning group respectively, whose age grades in nervous system, circulatory system and respiratory system was by far above 51, especially above 70. The patients' age grades in other group and digestive system had two climax age groups, which the one was 21 ～ 30, and the other was above 70. The patients' age grades in poisoning group was by far among 21 ～ 50, which the patients' amount of acute alcoholism was at the most. (4) In 12 568 cases of death group, the death amount of circulatory system, other group, respiratory system, nervous system and digestive system ranked at the lst,2nd,4th,5th 8th respectively, whose age grades was by far above 51, especially above 70,and the patients' amount of sudden cardiac death was at the most in the death amount of circulatory system. The death amount of trauma and poisoning group ranked at the 3rd, 6th respectively, whose age grades was by far among 21 ～ 50. (5)The total amount, the death amount and the sudden cardiac death amount of male patients were more than those of female patients. (6)The percentage of the death group to the pre-hospital medical care group was 5.20%, and the percentage of the sudden cardiac death group to the pre-hospital medical care group was 1.29%,and the percentage of the sudden cardiac death group to the death group was 24.87 %, and the percentage of the sudden cardiac death group to the circulatory system group was 67.33 %. Conclusions ( 1 )The trauma and the sudden cardiac death are the overriding reason of disease and the overriding reason of death in our large and medium-sized cities respectively. (2) It is very important to cut the death rate of the middle-old age patients by strengthening prevention and cure of cardiovascular and cerebrovascular diseases, discerning the critical illness early and improving the level of pre-hospital medical care. (3)It is a strong method to decrease the total amount and the death amount of the trauma, especially in traffic accident, by strengthening safety in production, observing traffic regulation and enhancing the legal awareness.