CAJ | 학술논문

目的：总结分析近五年儿童重症监护病房（PICU）中内科死亡病例的主要特点及相关变化。方法回顾性分析2008年1月至2012年12月期间PICU中330例内科死亡病例的临床资料。结果2008至2012年PICU病死率由5.85%降至3.96%，差异有统计学意义（P<0.05）。330例死亡病例中婴儿136例（41.21%），幼儿73例（22.12%），学龄前儿童51例（15.45%），学龄及青春期患儿70例（21.21%）。随年份变化，不同年龄组病死率的差异有统计学意义（趋势χ2=6.90，P=0.009）。各年份均以婴儿组的病死率较高；随时间推移，婴儿及幼儿组的病死率有下降趋势，而学龄及青春期组的病死率有上升趋势。致死疾病中，心血管系统（33.94%）占首位，其次为血液肿瘤（31.52%）；不同年龄组患儿的致死疾病分布差异有统计学意义（P<0.001），婴儿组以心血管疾病为主，其余三组均以血液肿瘤为主。死亡病例入PICU 24 h内行小儿危重病例评分，危重组占67.49%，极危重组占15.48%。住院时间与危重程度具有负相关性（r=-0.313， P<0.001）。结论近五年我院PICU病死率逐年下降，婴儿期心血管系统疾病及非婴儿期血液肿瘤是主要的致死疾病。入院时处于危重或极危重状态是导致住院早期死亡的原因。
목적：총결분석근오년인동중증감호병방（PICU）중내과사망병례적주요특점급상관변화。방법회고성분석2008년1월지2012년12월기간PICU중330례내과사망병례적림상자료。결과2008지2012년PICU병사솔유5.85%강지3.96%，차이유통계학의의（P<0.05）。330례사망병례중영인136례（41.21%），유인73례（22.12%），학령전인동51례（15.45%），학령급청춘기환인70례（21.21%）。수년빈변화，불동년령조병사솔적차이유통계학의의（추세χ2=6.90，P=0.009）。각년빈균이영인조적병사솔교고；수시간추이，영인급유인조적병사솔유하강추세，이학령급청춘기조적병사솔유상승추세。치사질병중，심혈관계통（33.94%）점수위，기차위혈액종류（31.52%）；불동년령조환인적치사질병분포차이유통계학의의（P<0.001），영인조이심혈관질병위주，기여삼조균이혈액종류위주。사망병례입PICU 24 h내행소인위중병례평분，위중조점67.49%，겁위중조점15.48%。주원시간여위중정도구유부상관성（r=-0.313， P<0.001）。결론근오년아원PICU병사솔축년하강，영인기심혈관계통질병급비영인기혈액종류시주요적치사질병。입원시처우위중혹겁위중상태시도치주원조기사망적원인。
Objectives To analysis the main characteristics and changes of the internal death in pediatric intensive care unit (PICU) in the past five years. Methods The clinical data of 330 death cases in PICU internal medicine were retrospectively analyzed from January 2008 to December 2012. Results The mortality rate in PICU dropped from 5.85%to 3.96% from 2008 to 2012. Among 330 death cases, 136 cases (41.2%) were infants, 73 cases (22.1%) were toddlers, 51 cases (15.45%) were preschoolers, and 70 cases (21.21%) were school-age and adolescence. In different years, the differences of distribution of death in different age groups were statistical significance (χ2=6.90, P=0.009). In all years, the infant had the highest death rate. As the time progresses, the death rate of the infant and young children decreases, while the death rate of the school-age and adolescence increases. Among the diseases caused death, the cardiovascular disease was the most common disease (33.94%), followed by hematologic malignancy (31.52%). The difference of distribution of the diseases caused death in different age group was statistically significant (P<0.01). The cardiovascular disease was main cause of death in infant, and the hematologic malignancy was the main cause of death in other three age groups. Within 24 h admission, the pediatric critical illness score (PCIS) had been assessed, 67.49% was critical and 15.48%was extremely critical. The hospitalization time was negatively correlated with PCIS (r=-0.313, P<0.001). Conclusions In the past five years, the mortality in PICU declined year by year. Cardiovascular disease in infancy and hematologic malignancy in non infancy are the leading cause of death in children. Admission in critical or extremely critical condition is the reason of early death in hospital.