中国急性心肌梗死患者住院时间及其延长的影响因素分析

Length of stay and associated factors in patients with acute myocardial infarction in China

目的:分析中国急性心肌梗死(AMI)患者住院时间及其延长的影响因素。方法:纳入2013年1月—2014年9月中国AMI注册研究(CAMI研究)登记的17019例存活出院患者,以中位住院时间将患者分为一般住院时间组及住院时间延长组,比较两组患者的基线特征、实验室检查、院内治疗、住院费用等数据,分析AMI患者住院时间延长的影响因素。结果:AMI患者平均住院时间为(11.05±6.82)d,中位住院时间为10(7,14)d,一般住院时间组(≤10 d)患者9311例,住院时间延长组(>10 d)患者7708例。女性住院时间长于男性[(11.35±7.26)d︰(10.95±6.67)d,P<0.001],>65岁患者的住院时间长于≤65岁患者[(11.54±7.99)d︰(10.70±5.83)d,P<0.001]。多因素分析显示,已(再)婚、市县级医院、心内科床位数、中西部地区医院、北方地区医院、高血压、吸烟史、就诊时心脏骤停、白细胞计数、血清钾、左心室射血分数、直接经皮冠状动脉介入治疗、冠状动脉旁路移植、应用主动脉球囊反搏、住院期间心力衰竭新发生或加重、严重心律失常、再次心肌梗死、出血事件是AMI患者住院时间的独立影响因素(均P<0.05)。结论:中国AMI患者住院时间较西方国家更长,医院级别、地区以及直接经皮冠状动脉介入治疗等18个变量为住院时间的独立影响因素。

Objective:To analyze the length of stay(LOS)and the associated factors in patients with acute myocardial infarction in China.Method:A total of 17019 survivors at discharge in the China Acute Myocardial Infarction(CAMI)Registry from January 2013 to September 2014 were included in the analysis.Patients were divided into two groups according to the median of LOS.Baseline characteristics,laboratory test results,treatments,and expenses were compared.Multivariable logistic regression model was used to analyze the associated factors of LOS.Result:Mean LOS was(11.05±6.82)days,and the median of LOS was 10 days.A total of 9311 patients were in general LOS group(≤10 d),while 7708 patients had longer LOS(>10 d).LOS of female was longer than that of male([11.35±7.26]d vs.[10.95±6.67]d,P<0.001),and LOS of patients over 65 years old was significantly longer than that of patients under 65 years old([11.54±7.99]d vs.[10.70±5.83]d,P<0.001).Marital status,prefecture-and county-level hospitals,beds in department of cardiology,hospitals in the Mid and West,hospitals in the North,hypertension,current smoker,cardiac arrest at admission,white blood cells,serum potassium,left ventricular ejection fraction,primary percutaneous coronary intervention,coronary artery bypass graft,intro-aortic balloon pump insertion,new or aggravated heart failure during hospitalization,severe arrhythmia,recurrent myocardial infarction,and bleeding events were independent associated factors of LOS in patients with acute myocardial infarction.Conclusion:Comparing with LOS in western countries,Chinese patients experienced a longer LOS.Eighteen variables including hospital level,region and primary percutaneous coronary intervention are independent associated factors of LOS.