update med_death_note name = #{item.name}, sex = #{item.sex}, age = #{item.age}, bed_no = #{item.bedNo}, dept_name = #{item.deptName}, record_date = #{item.recordDate}, behospital_date = #{item.behospitalDate}, death_date = #{item.deathDate}, behospital_situation = #{item.behospitalSituation}, tentative_diagnosis = #{item.tentativeDiagnosis}, treatment_process = #{item.treatmentProcess}, death_reason = #{item.deathReason}, death_diagnosis = #{item.deathDiagnosis}, rec_doctor = #{item.recDoctor}, rec_date = #{item.recDate}, audit_doctor = #{item.auditDoctor}, audit_date = #{item.auditDate}, whole_data = #{item.wholeData}, remark = #{item.remark}, gmt_modified = #{item.gmtModified}, modifier = #{item.modifier}, where rec_id = #{item.recId} and hospital_id = #{item.hospitalId} and behospital_code = #{item.behospitalCode}