2013-2014年我国城区支气管哮喘急性发作住院患者的临床特征及住院费用的回顾性调查

A multi-center retrospective study of clinical characteristics and hospitalization costs of patients hospitalized for asthma exacerbation in China during 2013-2014

目的 了解我国因支气管哮喘（哮喘）急性发作住院患者的临床特征及住院费用情况.方法 回顾性调查并分析全国29个省、自治区、直辖市的29家三级甲等医院2013-2014年因哮喘急性发作入院的患者.通过事先设计的病例报告表搜集患者的一般资料、入院前情况、治疗转归、并发症、住院费用及其构成等信息,并对住院费用的影响因素进行了分析.结果 共纳入3 240例患者,男性1 369例（42.3％）,女性1 871例（57.7％）.41.5％（1 346/3 240）的患者在入院前1年之内曾因哮喘急性发作住院治疗或急诊就诊,仅28.0％ （907/3 240）的患者在入院前规律应用哮喘治疗药物.共有73例（2.3％）入住重症监护室（ICU）,并应用机械通气.8例患者死亡,哮喘急性发作住院患者病死率为0.25％.所有患者住院费用中位数为9045（6 431,13 035）元,其中药品费占52.1％,辅助检查费占27.6％,治疗费占9.6％.药品费中,哮喘治疗药物费用仅占22.7％,而抗菌药物占44.0％.住院费用随着哮喘急性发作严重程度的增加而增加,入住ICU、应用机械通气、合并肺炎及入院前1年内有因哮喘急性发作住院或急诊就诊史患者的平均住院费用更高.结论 我国因哮喘急性发作住院的患者中女性占多数,不规律用药的患者比例高.我国哮喘急性发作患者的住院病死率低于国外文献报道.哮喘急性发作患者的单次住院费用显著高于哮喘患者全年维持治疗费用.药品费用占住院费用的大部分,而在药品费用中,抗菌药物所占比重最高.

Objective To study the characteristics of patients hospitalized for asthma exacerbation in 29 teaching hospitals in China and to evaluate the hospitalization costs of these patients.Methods This was a retrospective study and involved patients hospitalized for asthma exacerbation in 29 hospitals throughout China during 2013-2014.Information about the demographic features,conditions before the admission,the outcome,the complications,and the costs was collected using the pre-designed case report form.The influencing factors of the hospitalization costs were analyzed.Results 3 240 asthmatic patients （1 369 males and 1 871 females） were included and data were analyzed.There were 41.5% （1 346/3 240） patients who had a history of previous hospitalization or emergency department visits during the last year.Only 28.0% （907/3 240） patients had used asthma-controlling medications regularly before the admission.Seventy-three （2.3%） patients were admitted to ICU and used mechanical ventilation.Mortality among these patients hospitalized for asthma exacerbation was 0.25% （8/3 240）.The median hospitalization costs was 9 045（6 431,13 035） RMB.The costs of medications,examinations and treatment accounted for 52.1%,27.6%,and 9.6% respectively.The costs of asthma medications accounted for only 22.7% of the total medication costs,while the costs of antibiotics accounted for 44.0%.The patients who were admitted to ICU,used mechanical ventilation,complicated with pneumonia,or had a history of hospitalization or emergency department visits during the last year due to asthma exacerbations tended to cost more.Conclusion In this study,we demonstrated that only a minority of the patients had used asthma controllers regularly before the admissions with exacerbations.The in-hospital mortality of asthma patients in this study was much lower than that reported in other countries.The average cost of hospitalization was much higher than the yearly cost of maintenance therapy.Medication was the predominant component of the total hospitalization costs,and the costs of antibiotics made up the major part of the total medication costs.