血液病危重症患者的ICU转归及费用研究

Cost Analysis and Prognosis of the Critically Ill Patients with Hematological Diseases in ICU

目的分析化疗及造血干细胞移植后的血液病患者ICU转归及费用,探讨降低费用的方法。方法将ICU患者分为血液病组和非血液病组,比较两组的日均费用、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)评分、抗生素费用占总费用比例、呼吸机使用率及病死率。结果血液病组和非血液病组患者日均费用分别为(9258.81±3642.14)元和(6432.11±8030.85)元、抗生素费用占总费用比例分别为(25±13)%和(17±11)%、APACHEⅡ评分分别为(21.4±8.1)分和(15.8±8.5)分、病死率分别为58.2%和38.2%,差异有统计学意义(均P<0.05);两组患者呼吸机使用率分别为69.5%和52.3%,差异无统计学意义(P>0.05)。结论化疗及造血干细胞移植后感染的血液病患者较非血液病患者病情重、费用高、病死率高,应在达到入住ICU标准后,在APACHEⅡ评分较低时尽早进入ICU治疗,控制病情进展,安全度过危重期,降低病死率及费用。

Objective To analyze the cost and prognosis of the critically ill patients with hematological diseases after chemotherapy and hematopoietie stem cell transplantation （HSCT） in ICU. Methods All the patients in ICU were divided into hematological disease group and non - hematological disease group. The total cost, average daily cost, Acute Physiology andChronic Health Evaluation Ⅱ （APACHE Ⅱ ） score, ventilator utilization rate, antibiotic use, and mortality were compared be- tween the two groups. Results The average daily cost, percentage of antibiotics among all the costs, APACHE Ⅱ score, and mortality in the hematological disease group were （9 258. 81 ± 3 642. 14） yuan, （25 ± 13 ）%, （21.4 ± 8. 1 ）, and 58.2%,respectively, which were significantly different from those in the non - hematological disease group [ （ 6 432. 11 ±8 030. 85 ） yuan, （17 ±11）%, （15.8 ±8.5） and 38.2% 3 （allP 〈0. 05）. The ventilator utilization rate was 69. 5% in hematologicaldisease group and 52. 3% in non - hematological disease group （P 〉 0. 05）. Conclusion The critically ill patients with hema- tological diseases were inferior to the non - hematological diseases patients in terms of mortality and cost. The critically ill patients with hematological diseases should be transferred to ICU when their APACHE Ⅱscores remain low.