1、中国病案2023 年第 24 卷第 2 期 86 肿瘤发病趋于年轻化，如何做好恶性肿瘤的三级预防工作，预防和控制恶性肿瘤，是今后很长一段时间需要深入研究的工作。3.3 先天异常病种顺位 先天性畸形和染色体变异疾病儿童平均年龄在 4.4 岁，男女患病比例为1.57：1，主要病种是先天性心脏疾病(房间隔缺损，室间隔缺损)，脑发育不全，以及男性生殖器先天性畸形(隐睾等)。染色体核型异常是导致新生儿先天性疾病的重要因素6。近年来国家推出相应的惠民工程，特别针对贫困地区的免费治疗先天心脏病，因此，先天性心脏病儿童住院患者数稳步增 长7。二胎以及三胎政策，高龄产妇增加，也增加了疾病的发病率。因此，做好围产
2、期保健，如何保障优生优育是关键。3.4 儿童意外伤害类别 损伤、中毒和外因某些后果患者平均年龄为 5.7 岁，正处于顽皮时期，容易受外伤，男女患病比例为 1.66：1，该疾病患儿从2015 年起明显下降，疾病顺位也在下降，有研究显示损伤、中毒的外部原因主要有窒息等呼吸意外情况、跌倒坠落、异物、交通事故、烫伤(烧、腐蚀伤)等8-9。本研究显示，儿童外伤主因是跌倒/坠落，以及烫伤，2015 年以后此疾病减少的主要外因是儿童烫伤患者减少，随着国家近年对儿童卫生事业的重点关注，意外事件发生有所缓和。如何有效避免儿童意外事件的产生，做好安全防护，开展安全宣教，更好的呵护儿童健康成长10。参考文献 1 张
3、静,杨洋,金敏,等.某院 2014-2018 年日间手术中心住院病人疾病谱特征分析J.中国卫生统计,2021,38(1):84-86.2 冯学强,张雪峰,窦连杰,等.台州市某三级综合医院2011 年-2019 年出院患者疾病谱分析J.中国病案,2021,22(7):53-56.3 宇应涛,郭争社,范艳妮,等.2014 年-2019 年西安市某三甲医院住院儿童病例分析J.中国病案,2020,21(12):51-54.4 左蜀媛,韩淑华.新生儿高胆红素血症发病影响因素分析J.中国计划生育学杂志,2021,29(5):1054-1057.5 吴丕六,戴碧涛,余忠红,等.儿童白血病致病危险因素分析J.
4、中国循证医学杂志,2010,10(9):1037-1040.6 王红英,李海波,何亚香,等.新生儿先天畸形 396 例染色体异常核型及其表型临床特征分析J.中华实用儿科临床杂志,2014,29(20):1560-1563.7 龙美元,宋冬春.近 8 年某院住院儿童疾病谱的变化J.中国病案,2011,12(4):54-55.8 周君,阿尔达可纳汗.2012-2017 年新疆某医院儿童损伤中毒及外因分析J.中国医院统计,2019,26(5):353-355.9 翁禾.儿童损伤与中毒的原因分析J.中国病案,2018,19(1):63-65.10 杨霞,崔亚男,李吴萍.2011 年-2013 年某院儿
5、童意外损伤中毒住院病例分析J.中国病案,2015,16(2):62-64.(2021-11-22 收稿)某精神病专科医院非医嘱离院影响因素的Logistic回归分析 王智慧 闫军伟*摘要 目的 分析某精神病专科医院非医嘱离院患者的相关特征及影响因素，为加强医院管理，提高医疗服务质量提供参考。方法 从病案统计系统调取2019年7月1日-2021年6月30日出院患者数据16842例，根据离院方式分为医嘱离院组和非医嘱离院组，采用 Logistic 回归分析非医嘱离院的相关因素。结果 16 842 例出院患者中，医嘱离院 16 077 例，非医嘱离院 765 例。Logistic 回归分析显示付费方
6、式(自费，OR=1.51)、住院天数(大于等于 35 天，OR=0.23)、入院病情(临床未确定、情况不明和无，OR=1.45)、现住址(外地，OR=1.20)是造成患者非医嘱离院的主要影响因素。非医嘱离院患者中自费者占 27.71%，住院天数35 天占 85.62%，入院病情临床未确定、情况不明和无者占 7.58%，居住在外地者占 60.26%；医嘱离院患者中自费者占 18.22%，住院天数 35 天占 47.56%，入院病情临床未确定、情况不明和无者占 4.37%，居住在外地者占 52.36%。非医嘱离院位居首位的疾病类型是心境情感障碍，占 48.89%；而医嘱离院位居首位的疾病类型是精神
7、分裂症、分裂型障碍和妄想性障碍，占 39.25%。结论 自费、入院病情临床未确定，情况不明和无、居住在外地和住院天数35 天是影响患者非医嘱离院的重要因素，医院应采取针对性的措施，减少非医嘱离院的发生。关键词 非医嘱离院；Logistic 回归；影响因素；医院管理1 Logistic Regression Analysis on Influencing Factors of Discharge Against Medical Advice in a Psychiatric Hospital Logistic Regression Analysis on Influencing Factors
8、of Discharge Against Medical Advice in a Psychiatric Hospital Wang Zhihui,Yan Junwei*Abstract Abstract ObjectivesObjectives To analyze the relevant characteristics and influencing factors of discharge against medical advice in a psychiatric hospital,and to provide references for strengthening hospit
9、al management and improving the quality of medical services.Methods Methods The data of 16842 discharged patients from July 1st,2019 to June 30th,2021 were retrieved from the medical record statistics system.All research subjects were divided into the group of patients who left the hospital against
10、medical advice and the group of patients who left the hospital with medical advice.Logistic regression was used to analyze the related factors of discharge against medical advice.ResultsResults Among the 16,842 discharged patients,16077 were discharged inpatients with medical advice and 765 were 基金项
11、目：合肥市卫健委应用医学重点研究项目(编号：Hwk2021zd011)；合肥市第四人民医院院内科研项目(项目编号：HFSY2020YB13)安徽医科大学附属心理医院 安徽省精神卫生中心 合肥市第四人民医院，安徽省，合肥市，230031*通讯作者 中国病案2023 年第 24 卷第 2 期 87 discharged inpatients against medical advice.Logistic regression analysis showed that payment method(self-financed,OR=1.51),length of hospital stay(35 d
12、ays,OR=0.23),condition of admission(clinically uncertain,unclear and no,OR=1.45),current address(outland,OR=1.20)were the main influencing factors that caused patients to leave the hospital against medical advice.Among the 765 discharged inpatients against medical advice,the proportion of self-payer
13、s was 27.71%,hospitalization less than 35 days was 85.62%,admission without medical conditions was 7.58%and living outside was 60.26%.Among the 16077 discharged inpatients with medical advice,the proportion of self-payers was 18.22%,hospitalization less than 35 days was 47.56%,admission without medi
14、cal conditions was 4.37%and living outside was 52.36%.The most common type of diseases discharged from hospital against medical advice was mood disorder,accounting for 48.89%.The most common type of diseases discharged from hospital with medical advice was schizophrenia,schizophrenic disorder and de
15、lusional disorder,accounting for 39.25%.Conclusions Conclusions Self-payers,admission without medical conditions,living outside and hospitalization less than 35 days are important factors that affect patients leaving the hospital against medical advice.The hospital should take targeted measures,pay
16、attention to key populations of key diseases,and provide appropriate post-discharge guidance,so as to reduce the occurrence and negative impact of discharge against medical advice.Key wordsKey words Discharge against medical advice；Logistic regression；Influencing factor；Hospital management FirstFirst-authorauthors address s address The Affiliated Psychological Hospital of Anhui Medical University,Anhui Mental Health Center,The Fourth Peoples Hospital of Hefei,Hefei 230031,Anhui Province,China Co