ST段抬高型心肌梗死患者住院费用构成及影响因素的分析

Study on the Composition and Influential Factors of Hospitalization Costs of Acute ST-segment Elevation Myocardial Infarction

目的分析急性ST段抬高型心肌梗死(STEMI)患者住院费用及其构成特点,探讨各相关因素对住院费用的影响,为合理控制医疗费用提供依据。方法收集2016年1月1日-2018年12月31日出院的急性ST段抬高型心肌梗死病例1554例,对住院病案首页信息进行回顾性分析,并对可能相关该疾病住院费用的因素进行单因素分析和多元线性回归分析,明确影响急性ST段抬高型心肌梗死(STEMI)患者住院费用的影响因素。结果患者人均住院总费用呈逐年递增趋势,平均总住院费用为73572.60元,其中材料费占比最高,占人均住院费用的65.27%,其次是检查化验费占10.91%;药费占9.85%。多元线性回归结果显示,住院天数、支架数量、使用呼吸机、转归、有无心源性休克、有无糖尿病、手术方式等对住院费用影响有统计学意义,P<0.05,其中患者的住院天数对住院费用影响最大(b′=0.47),其次是支架数量(b′=0.37),手术方式(b′=0.36)。死亡患者费用明显高于存活患者(b=40.71),并发心源性休克患者费用明显高于没有休克的患者(b=27.78),合并糖尿病患者费用明显高于没有糖尿病的患者(b=5.25)。结论住院天数和使用卫生材料是影响STEMI患者住院费用的主要因素。因此实施临床路径,降低材料和检查费用,预防并发症发生,缩短平均住院日,有助于合理控制医疗费用。

Objective To analyze the hospitalization expenses of patients with acute ST-segment elevation myocardial infarction(STEMI)and the composition features,and to discuss the effects of each related factor on the hospitalization expenses,so as to provide basis for reasonable control of medical expenses.Methods 1554 patients with acute STEMI discharged from January 1,2016 to December 31,2018 were collected for retrospective analysis of information on the home page of medical record,and single factor analysis and multiple linear regression analysis were made on the factors that might influence the hospitalization expenses of such disease to identify the influencing factors of hospitalization expenses of patients with acute ST-segment elevation myocardial infarction(STEMI).Results The total hospitalization expense per capita of patients tended to increase year by year,with the average total hospitalization expense of 73572.60 yuan,where the proportion of material expenses was the highest,65.27%;followed by laboratory examination expenses,10.91%;and medicine expenses,9.85%.the multiple linear regression result showed that the length of stay,number of heart stents,use of medical ventilator,outcome,disease with or without cardiogenic shock,disease with or without diabetes mellitus and operation mode had statistically significant effects on the hospitalization expenses of patients,P<0.05,where the length of stay had the biggest effect on the hospitalization expenses(b′=0.47),followed by the number of heart stents(b′=0.37),methods ofoperation(b′=0.36);the expenses of dead patients were significantly higher than those of survival patients(b=40.71),the expenses of patients with cardiogenic shock were significantly higher than those of patients without cardiogenic shock(b=27.78),and the expenses of patients with diabetes mellitus were significantly higher than those of patients without diabetes mellitus(b=5.25).Conclusion The length of stay and the use of hygienic materials constitute the main factors that would influence the hospitalization expenses of patients with STEMI.Therefore,implementation of clinical pathway,reduction of material and examination expenses,prevention of complications and shortening of average length of stay would be helpful for reasonable control of medical expenses.