区域医疗中心咳嗽患者临床特征及就诊流向的大数据挖掘分析

谢仁炜; 王朝昕; 李云霞; 沈宇; 何琳; 石建伟; 姜丽秋; 石宝平; 肖洁汶

doi:10.16766/j.cnki.issn.1674-4152.002789

区域医疗中心咳嗽患者临床特征及就诊流向的大数据挖掘分析

doi: 10.16766/j.cnki.issn.1674-4152.002789

谢仁炜¹,
王朝昕²,
李云霞³,
沈宇⁴,
何琳³,
石建伟²,
姜丽秋⁵,
石宝平⁶,
肖洁汶^{3, 7}

1.
上海市宝山区仁和医院科教科，上海 200431
2.
上海交通大学公共卫生学院社会医学与卫生管理学系，上海 200020
3.
上海市宝山区仁和医院院办
4.
上海市宝山区仁和医院信息科
5.
上海市宝山区仁和医院医务科
6.
上海市宝山区仁和医院呼吸内科
7.
上海市宝山区吴淞中心医院院办, 上海 200940

基金项目:

上海市浦江人才计划项目 2019PJC072

上海市卫生和计划生育委员会科研课题 20184Y0117

上海市宝山区科学技术委员会科技创新专项资金项目 19-E-10

详细信息

中图分类号: R441.5 R197.323.1
计量
- 文章访问数: 298
- HTML全文浏览量: 153
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-09
- 网络出版日期: 2023-02-07

Big data mining analysis of the clinical characteristics and direction in seeking medical service of cough patients in regional medical centres

1.
Science and Education Section Department of Shanghai Baoshan District Renhe Hospital, Shanghai 200431, China

摘要

摘要: 目的分析区域医疗中心门诊有咳嗽症状患者的临床特征及就诊流向，了解其临床特点，为相关研究提供流行病学依据，同时为区域医疗中心优化咳嗽患者分诊提供参考。方法收集2017年1月1日—2019年12月31日上海市某区域医疗中心3年的门诊数据，分析其中有咳嗽症状患者的症状、主要诊断及就诊流向。结果该医疗中心3年共接诊有咳嗽症状的门诊患者110 240人次，占总门诊量的5.85%，2017—2019年门诊有咳嗽症状的患者数量和占比均呈增长趋势。患者年龄为51.0(21.5, 64.0)岁，女性57 868人次(52.49%)，男性52 372人次(47.51%)，女性占比高于男性(χ²=274.002, P＜0.001)。按咳嗽病程分类，急性咳嗽(时间＜3周)103 702人次(94.07%)，亚急性咳嗽(时间3~8周)3 343人次(3.03%)，慢性咳嗽(时间＞8周)3 195人次(2.90%)，不同咳嗽类型在不同年龄组、性别组中分布差异均有统计学意义(均P＜0.05)。咳嗽患者伴随症状前3位分别为咳痰、发热和流涕，主要诊断前3位分别为呼吸道感染、急性咽炎和急性上呼吸道感染，此外，咳嗽伴随症状和主要诊断在不同咳嗽类型分组和不同年龄分组中的分布不同。咳嗽患者就诊流向较集中，主要为急诊内科、儿科和呼吸内科。结论门诊就诊患者中有咳嗽症状的数量呈增长趋势，各类型咳嗽在不同人群分组中分布存在差异。
- 门诊 /
- 咳嗽 /
- 临床特征 /
- 就诊流向 /
- 大数据
Abstract: Objective To analyse the clinical characteristics and direction in seeking medical service of patients with cough symptoms in regional medical centres, understand the clinical characteristics of cough patients, provide epidemiological basis for related clinical research, and offer a reference for regional medical centres to optimise the triage of cough patients. Methods This study collected three-year outpatient data of a regional medical centre in Shanghai from January 1, 2017 to December 31, 2019 and analysed the symptoms, main diagnosis and direction in seeking medical service of patients with cough symptoms. Results A total of 110 240 outpatients with cough symptoms were received from 2017 to 2019, accounting for 5.85% of the total outpatients. The number and proportion of outpatients with cough symptoms showed an increasing trend. The average age of patients was 51.0 (21.5, 64.0) years old, with 57 868 female (52.49%) and 52 372 male (47.51%) patients. The proportion of female patients was higher than that of male (χ²=274.002, P < 0.001). According to the classification of cough duration, 94.07% (103 702) had acute cough (cough time < 3 weeks), 3.03%(3 343) had subacute cough (cough time 3-8 weeks), and 2.90% (3 195) had chronic cough (cough time > 8 weeks). The distributions of different types of coughs in age and gender groups differed (all P < 0.05). The top three associated symptoms of cough patients were expectoration, fever and runny nose. The top three main diagnoses were respiratory tract infection, acute pharyngitis and acute upper respiratory tract infection. The distributions of cough associated symptoms and main diagnosis in different cough types and different age groups were different. In addition, the main departments receiving patients with cough were Emergency Department, Paediatrics and Respiratory Medicine. Conclusion The number of outpatients with cough symptoms shows an increasing trend, and the distributions of different types of coughs in the population group is different.
- Outpatient /
- Cough /
- Clinical characteristics /
- Direction in seeking medical service /
- Big data

HTML全文

图 1 咳嗽患者诊断前30位疾病分布情况(ICD-10)

Figure 1. Distribution of the top 30 diagnoses (ICD-10) in cough patients

下载: 全尺寸图片幻灯片

表 1 2017—2019年上海市某区域医疗中心门诊就诊患者咳嗽情况[人次(%)]

Table 1. Outpatients with or without cough in a regional medical center in Shanghai, 2017—2019 [n(%)]

年份	咳嗽	非咳嗽	总就诊
2017	17 508(3.91)	430 389(96.09)	447 897(23.77)
2018	33 982(4.89)	661 562(95.11)	695 544(36.91)
2019	58 750(7.93)	682 320(92.07)	741 070(39.32)
合计	110 240(5.85)	1 774 271(94.15)	1 884 511(100.00)

下载: 导出CSV

表 2 2017—2019年上海市某区域医疗中心咳嗽患者基本情况[人次(%)]

Table 2. Characteristics of cough patients in a regional medical center in Shanghai, 2017—2019 [n(%)]

项目	咳嗽类型			χ²值	P值
项目	急性	亚急性	慢性	χ²值	P值
性别				31.767	＜0.001
男性	49 202(93.95)	1 512(2.89)	1 658(3.16)
女性	54 500(94.18)	1 831(3.16)	1 537(2.66)
年龄(岁)				5 474.977	＜0.001
1~19	38 334(99.24)	241(0.62)	54(0.14)
20~39	26 413(94.45)	1 053(3.77)	498(1.78)
40~59	18 883(91.93)	931(4.54)	726(3.53)
60~79	16 835(87.77)	976(5.09)	1 370(7.14)
80岁及以上	3 237(82.45)	142(3.62)	547(13.93)
就诊年份				98.320	＜0.001
2017	16 226(92.68)	624(3.56)	658(3.76)
2018	31 902(93.88)	1 099(3.23)	981(2.89)
2019	55 574(94.59)	1 620(2.76)	1 556(2.65)
合计	103 702(94.07)	3 343(3.03)	3 195(2.90)

下载: 导出CSV

表 3 不同类型咳嗽的前10位诊断疾病分析(ICD-10)

Table 3. Distribution of the top 10 diagnoses (ICD-10) with different types of cough

序位	急性咳嗽诊断	慢性咳嗽诊断	亚急性咳嗽诊断
1	J98.900	J98.900	J98.900
2	J02.900	J42.X00	J40.X00
3	J06.900	R05.X00	J18.900
4	J20.900	J44.000	R05.X00
5	J18.900	J45.900	J20.900
6	J03.900	J44.900	J06.900
7	J40.X00	J40.X00	J02.900
8	R50.900	J18.900	R05.X51
9	J18.000	J47.X03	R91.X00
10	J21.901	R91.X00	J45.005

下载: 导出CSV

表 4 不同年龄组咳嗽患者前10位诊断疾病分布情况(ICD-10)

Table 4. Distribution of the top 10 diagnoses (ICD-10) in cough patients by age group

序位	1~19岁	20~39岁	40~59岁	60~79岁	80岁及以上
1	J02.900	J98.900	J98.900	J98.900	J98.900
2	J20.900	J06.900	J06.900	J18.900	J18.900
3	J03.900	J40.X00	J18.900	J06.900	J42.X00
4	J06.900	J18.900	J40.X00	J40.X00	J44.000
5	J18.000	J02.900	J20.900	J20.900	J40.X00
6	J21.901	R50.900	J02.900	J42.X00	J06.900
7	J98.900	J20.900	R50.900	J02.900	J98.414
8	K29.100	R05.X00	R05.X00	R50.900	I25.103
9	K92.901	J03.900	J45.900	J44.000	J20.900
10	J11.101	J39.900	J39.900	J45.900	R50.900

下载: 导出CSV

表 5 咳嗽患者就诊科室流向分析(人次)

Table 5. Distribution of departments visited by cough patients (n)

序位	科室	咳嗽患者	咳嗽类型			咳嗽患者占科室就诊比例(%)
序位	科室	咳嗽患者	急性咳嗽	慢性咳嗽	亚急性咳嗽	咳嗽患者占科室就诊比例(%)
1	急诊内科	44 159	43 106	482	571	10.86
2	儿科	35 261	35 060	32	169	37.48
3	呼吸内科	24 389	19 650	2 399	2 340	55.48
4	耳鼻喉科	2 294	2 120	59	115	3.35
5	普外科	855	793	48	14	0.56
6	中医内科	835	735	33	67	2.06
7	内分泌内科	461	437	20	4	0.27
8	老年科	455	449	5	1	1.08
9	心血管内科	397	346	35	16	0.27
10	消化内科	358	342	8	8	0.30

下载: 导出CSV

参考文献(19)

[1]	龚雪, 牟方政, 魏大荣, 等. 225例新型冠状病毒肺炎的临床特征及中医药应用分析[J]. 世界中医药, 2020, 15(6): 819-826. doi: 10.3969/j.issn.1673-7202.2020.06.002 GONG X, MOU F Z, WEI D R, et al. The Clinical Characteristics and Medication Analysis of Corona Virus Disease 2019[J]. World Chinese Medicine, 2020, 15(6): 819-826. doi: 10.3969/j.issn.1673-7202.2020.06.002
[2]	楚辉, 张杰. 呼出气一氧化氮检测在亚急性咳嗽临床诊治中的意义[J]. 河北医学, 2022, 28(5): 847-852. doi: 10.3969/j.issn.1006-6233.2022.05.031 CHU H, ZHANG J. Significance of Exhaled Nitric Oxide in Clinical Diagnosis and Treatment of Subacute Cough[J]. Hebei Medicine, 2022, 28(5): 847-852. doi: 10.3969/j.issn.1006-6233.2022.05.031
[3]	中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2015)[J]. 中华结核和呼吸杂志, 2016, 39(5): 323-354. doi: 10.3760/cma.j.issn.1001-0939.2016.05.003 Asthma Group of Chinese Thoracic Society. Chinese national guideline on diagnosis and management of cough(2015)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2016, 39(5): 323-354. doi: 10.3760/cma.j.issn.1001-0939.2016.05.003
[4]	CHEN R J, YIN P, MENG X, et al. Fine particulate air pollution and daily mortality. A nationwide analysis in 272 Chinese cities[J]. Am J Respir Crit Care Med, 2017, 196(1): 73-81. doi: 10.1164/rccm.201609-1862OC
[5]	汪锋, 刘辛. 空气污染与呼吸系统疾病发病率的关系分析[J]. 重庆大学学报, 2021, 44(4): 97-106. https://www.cnki.com.cn/Article/CJFDTOTAL-FIVE202104010.htm WANG F, LIU X. The relationship of air pollution and respiratory diseases: Evidence from micro data of a hospital in Chongqing[J]. Journal of Chongqing University, 2021, 44(4): 97-106. https://www.cnki.com.cn/Article/CJFDTOTAL-FIVE202104010.htm
[6]	王道涵, 周霈炀, 蒋晨茜, 等. 大气细颗粒物对呼吸系统的影响[J]. 科技视界, 2021(6): 103-104. https://www.cnki.com.cn/Article/CJFDTOTAL-KJSJ202106040.htm WANG D H, ZHOU P Y, JIANG C Q, et al. Effects of atmospheric fine particulate matter on the respiratory system[J]. Science & Technology Vision, 2021(6): 103-104. https://www.cnki.com.cn/Article/CJFDTOTAL-KJSJ202106040.htm
[7]	李沛. 北京市大气颗粒物污染对人群健康的危害风险研究[D]. 兰州: 兰州大学, 2016. LI P. Study on hazard risk of atmospheric particulate matter to the population health in Beijing[D]. Lanzhou: Lanzhou University, 2016.
[8]	徐荣, 詹晨, 刘家兴, 等. 广州地区呼吸专科门诊咳嗽症状分布调查[J]. 中国呼吸与危重监护杂志, 2017, 16(5): 495-499. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGHW201705025.htm XU R, ZHAN C, LIU J X, et al. A survey on distribution of cough symptom in outpatients from respirologist in Guangzhou[J]. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(5): 495-499. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGHW201705025.htm
[9]	李婧辰. 我国40岁及以上人群咳嗽、咳痰现况及影响因素研究[D]. 北京: 中国疾病预防控制中心, 2017. LI J C. Prevalence and influencing factors of respiratory symptoms among people aged 40 years and above in China[D]. Beijing: Chinese Center for Disease Control and Prevention, 2017.
[10]	王贤诚, 刘桂萍, 张星亮, 等. 支气管镜下气道炎症状态评估在慢性咳嗽患儿中应用[J]. 中华实用诊断与治疗杂志, 2018, 32(6): 545-547. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD201806007.htm WANG X C, LIU G P, ZHANG X L, et al. Application of bronchoscopic evaluation of airway inflammation in children with chronic cough[J]. Journal of Chinese Practical Diagnosis and Therapy, 2018, 32(6): 545-547. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD201806007.htm
[11]	张娜莉, 马原, 田玉恆, 等. 583例慢性咳嗽病例特征及影响因素分析[J]. 华南预防医学, 2021, 47(6): 791-793. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202106024.htm ZHANG N L, MA Y, TIAN Y H, et al. An analysis of the characteristics and influencing factors of 583 patients with chronic cough[J]. South China Journal of Preventive Medicine, 2021, 47(6): 791-793. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202106024.htm
[12]	LIU Q, XU C, JI G X, et al. Effect of exposure to ambient PM2.5 pollution on the risk of respiratory tract diseases: A meta-analysis of cohort studies[J]. J Biomed, 2017, 31(2): 130-142.
[13]	周艳, 王越, 陈信. 217例儿童慢性咳嗽病因构成及临床特征研究[J]. 中华全科医学, 2020, 18(1): 19-22, 55. doi: 10.16766/j.cnki.issn.1674-4152.001157 ZHOU Y, WANG Y, CHEN X. Ratio of component causes and clinical features of chronic cough: a report of 217 cases[J]. Chinese Journal of General Practice, 2020, 18(1): 19-22, 55. doi: 10.16766/j.cnki.issn.1674-4152.001157
[14]	蔡光云, 蔡燕君, 周晓燕, 等. 老年慢性咳嗽的病因诊断与治疗分析[J]. 中国处方药, 2021, 19(2): 167-168. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF202102090.htm CAI G Y, CAI Y J, ZHOU X Y, et al. The etiological diagnosis and treatment analysis of chronic cough in the elderly[J]. Journal of China Prescription Drug, 2021, 19(2): 167-168. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF202102090.htm
[15]	王荣花. 综合心理护理干预对老年咳嗽变异性哮喘患者的影响[J]. 心理月刊, 2021, 16(11): 163-164. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202111080.htm WANG R H. Efficacy of comprehensive psychological nursing intervention on elderly patients with cough variant asthma[J]. Psychologies Magazine, 2021, 16(11): 163-164. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202111080.htm
[16]	卢彦帮, 陈宏. 成人常见咳嗽原因的临床分析[J]. 医学综述, 2018, 24(11): 2216-2220. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201811027.htm LU Y B, CHEN H. Clinical analysis of causes of common cough in adults[J]. Medical Recapitulate, 2018, 24(11): 2216-2220. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201811027.htm
[17]	王怀于. 分析成人慢性咳嗽的病因, 探讨其诊断与治疗[J]. 中西医结合心血管病电子杂志, 2020, 8(26): 177-181. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202026124.htm WANG H Y. Analysis of the causes of chronic cough in adults and discussion of its diagnosis and treatment[J]. Cardiovascular Disease Electronic Journal of integrated traditional Chinese and Western Medicine, 2020, 8(26): 177-181. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202026124.htm
[18]	YI F, CHEN R C, LUO W, et al. Validity of fractional exhaled nitric oxide in diagnosis of corticosteroid responsive cough[J]. Chest, 2016, 149(4): 1042-1051.
[19]	LAI K F, LONG L, YI F, et al. Age and sex distribution of Chinese chronic cough patients and their relationship with capsaicin cough sensitivity[J]. Allergy Asthma Immunol Res, 2019, 11(6): 871-884.