中国城市医院糖尿病截肢的临床特点及医疗费用分析

Clinical characteristics and medical costs of diabetics with amputation at central urban hospitals in China

目的 调查中国城市医院糖尿病截肢率、分析糖尿病截肢的临床特点、医疗费用及其影响因素.方法 对全国39家三甲医院2010年全年糖尿病截肢患者进行回顾性地调查,分析内容包括人口学特征、糖尿病并发症、糖尿病足病的Wagner分级、截肢平面及转归、住院日及住院总费用等.结果 2010年39家医院共有1684例患者截肢.糖尿病足截肢者475例（28.2％）,占非创伤性截肢的39.5％（475/1204）.475例糖尿病截肢患者男性65.9％,平均年龄（66±12）岁,平均糖尿病病程（130±94）个月,HbA1c水平8.9％±2.4％.糖尿病截肢患者合并神经病变者为50.1％（219/437）、下肢动脉病变74.8％（326/436）、肾病28.4％（124/436）、视网膜病变25.9％ （113/436）；糖尿病截肢患者以Wagner 4级患者最多,占50.3％,小截肢占67.5％,住院时间为33.0 （24.0～45.O）d,住院费用为26 138（16 155～46 021）元.糖尿病病程、糖尿病慢性并发症、糖尿病足溃疡的分级、截肢部位、截肢预后对住院时间及费用有显著影响.结论 糖尿病截肢患者具有高龄、病程长、慢性并发症多、血糖控制差、多数合并足部分坏疽、小截肢率高、一期愈合率低的特点；住院时间长,医疗费用高.病程＞20年,合并有糖尿病神经病变、下肢动脉病变、肾病、视网膜病变,溃疡分级的增加、大截肢及多次截肢的患者,住院时间显著延长,医疗费用明显增加.

Objective To explore the clinical characteristics,medical costs and its influencing factors in diabetics with amputation.Methods The data of diabetic amputation for the whole year of 2010 at 39 central municipal Class 3A hospitals all across China were retrospectively analyzed according to a unified protocol,including demographic characteristics, diabetic complications, classification of diabetic foot disease,level and prognosis of amputation and medical costs at hospitals.Results Among them,28.2 % of all amputated patients or 39.5% of non-traumatic patients were diabetics.There were 313 males and 162 females.The average age and duration of diabetes were （66 ± 12） years and （ 130 ±94） months.The level of HbA1c was 8.9% ± 2.4%. Among all amputated diabetics,the concurrent conditions included neuropathy （ 50.1% ）,peripheral artery disease （ 74.8% ）,nephropathy （ 28.4% ） and retinopathy （25.9%）.The patients with foot ulcer at Wagner 4 （50.3% ） were more common.Among them,67.5% had minor amputation with a median hospitalization stay of 33.0 （24.0 -45.O）days and a medical cost of 26 138（ 16 155 - 46 021 ） yuan RMB. The duration of diabetes,diabetic complications,severity and location of ulcers and amputation level influenced their hospitalization durations and medical costs.Conclusion The patients with diabetes and amputation are elder with more chronic diabetic complications and uncontrolled hyperglycemia. Most of them have complications of local gangrene and require minor amputation at admission.Their hospital stays are longer and medical costs higher significantly correlated with diabetic complications,severity and location of foot ulcers and level of amputations. Keywords：Diabetic ; Foot; Amputation; Fees,medical