基于HIS数据的糖尿病死亡人群临床特征及中西药物联合应用分析(1)
[摘要] 为了解糖尿病死亡人群临床特征以及合并用药分布情况，从全国20家三甲综合医院医院信息系统中提取糖尿病死亡患者住院信息，运用频数统计以及关联规则方法，分析糖尿病死亡人群的一般信息、合并疾病、联合用药、死亡时间规律等。结果发现糖尿病死亡人群中，中老年人居多，且男性大于女性；共病频率较高的疾病有高血压病、肺部感染、冠心病、脑梗死、肾功能不全；联合用药规律是西药胰岛素、呋塞米、多巴胺、尼可刹米、碳酸氢钠联合使用的频率最高，中药三七、柴胡等与西药联合使用频率次之，而中药之间联合使用的频率最低。死亡人群中以中老年人居多且男性大于女性；死亡时辰以申时、酉时最多，为阳明欲解时。因此，真实世界中糖尿病死亡人群以合并心脑血管疾病居多，临床应注意早期预防；临床用药方案基本符合糖尿病临床治疗指南，活血化瘀、疏肝解郁类药物是治疗糖尿病的常用中药。
[关键词]糖尿病；中医时间学；医院信息系统；真实世界；联合用药
[Abstract] To understand the clinical characteristics and distribution of combined treatment of Chinese and western medicine in diabetes deaths， the hospitalization information of diabetes deaths from HIS system of 20 national 3A-grade general hospitals. Then the frequency statistics and association rules analysis were used to analyze the general information， complications， combined treatment， death time and other information of the patients died from diabetes. The results showed that most of the diabetes deaths were of middle aged and elderly people， more often in males than females. The complications with higher incidence included hypertension， pulmonary infection， coronary heart disease， cerebral infarction and renal inadequacy. In combined treatment rules， western medicines insulin， cefuroxime， furosemide， dopamine， nikethamide and sodium bicarbonate were used in combination at highest frequencies， followed by the combinations of traditional Chinese medicines panax notoginseng， radix bupleuri and western medicines， and the combinations between Chinese medicines had the lowest use frequency. Most of the diabetes deaths were of middle aged and elderly people， more often in males than females. They mainly died from 3 pm to 5 pm and from 5 pm to 7 pm. Therefore， the diabetes deaths often had complications of cardiovascular and cerebrovascular diseases， and early prevention shall be noted in clinics； the clinical treatment plan was basically in accordance with the guidelines for clinical treatment of diabetes； the drugs with promoting blood circulation to remove blood stasis and soothing liver-qi stagnation effects were the common Chinese medicines in treatment of diabetes.
[Key words] diabetes； time theory of traditional Chinese medicine； hospital information system； real world； combined medication
doi：10.4268/cjcmm20161106
糖尿病是一组由多种原因引起的胰岛素分泌或作用缺陷，以慢性高血糖为特征的内分泌代谢病。典型临床表现为多饮、多食、多尿及消瘦。由于长期碳水化合物以及脂肪、蛋白质代谢紊乱可引起多系统损害，导致心、脑、肾、眼、神经、血管等器官慢性进行性病变。严重者可发生急性代谢紊乱，如酮症酸中毒、高渗型昏迷且易诱发各种感染[1]，其急慢性并发症，尤其是慢性并发症累及多器官受累而且致残、致死率高，是导致死亡的重要原因。为了解糖尿病死亡人群的临床特征及联合用药规律，本研究依托全国20家三级甲等医院信息系(hospital information system，HIS)中糖尿病死亡人群住院信息，重点对其临床特征及中西药物使用情况进行分析，为临床医生更好地认识该疾病特点并制定相应的防治措施提供科学依据。 (金德 谢雁鸣 张寅 姜俊杰 张一开 庄严)
[关键词]糖尿病；中医时间学；医院信息系统；真实世界；联合用药
[Abstract] To understand the clinical characteristics and distribution of combined treatment of Chinese and western medicine in diabetes deaths， the hospitalization information of diabetes deaths from HIS system of 20 national 3A-grade general hospitals. Then the frequency statistics and association rules analysis were used to analyze the general information， complications， combined treatment， death time and other information of the patients died from diabetes. The results showed that most of the diabetes deaths were of middle aged and elderly people， more often in males than females. The complications with higher incidence included hypertension， pulmonary infection， coronary heart disease， cerebral infarction and renal inadequacy. In combined treatment rules， western medicines insulin， cefuroxime， furosemide， dopamine， nikethamide and sodium bicarbonate were used in combination at highest frequencies， followed by the combinations of traditional Chinese medicines panax notoginseng， radix bupleuri and western medicines， and the combinations between Chinese medicines had the lowest use frequency. Most of the diabetes deaths were of middle aged and elderly people， more often in males than females. They mainly died from 3 pm to 5 pm and from 5 pm to 7 pm. Therefore， the diabetes deaths often had complications of cardiovascular and cerebrovascular diseases， and early prevention shall be noted in clinics； the clinical treatment plan was basically in accordance with the guidelines for clinical treatment of diabetes； the drugs with promoting blood circulation to remove blood stasis and soothing liver-qi stagnation effects were the common Chinese medicines in treatment of diabetes.
[Key words] diabetes； time theory of traditional Chinese medicine； hospital information system； real world； combined medication
doi：10.4268/cjcmm20161106
糖尿病是一组由多种原因引起的胰岛素分泌或作用缺陷，以慢性高血糖为特征的内分泌代谢病。典型临床表现为多饮、多食、多尿及消瘦。由于长期碳水化合物以及脂肪、蛋白质代谢紊乱可引起多系统损害，导致心、脑、肾、眼、神经、血管等器官慢性进行性病变。严重者可发生急性代谢紊乱，如酮症酸中毒、高渗型昏迷且易诱发各种感染[1]，其急慢性并发症，尤其是慢性并发症累及多器官受累而且致残、致死率高，是导致死亡的重要原因。为了解糖尿病死亡人群的临床特征及联合用药规律，本研究依托全国20家三级甲等医院信息系(hospital information system，HIS)中糖尿病死亡人群住院信息，重点对其临床特征及中西药物使用情况进行分析，为临床医生更好地认识该疾病特点并制定相应的防治措施提供科学依据。 (金德 谢雁鸣 张寅 姜俊杰 张一开 庄严)