医疗保险状态对急性缺血性脑卒中患者选择静脉内溶栓治疗的影响  

The Association between Medicare Status and Patients' Decision to Receive Intravenous Thrombolysis in Acute Ischemic Stroke

作　　者：刘枫荻 赵蓉[1] 王硕[1] 沈皛磊 李格飞 史妍慧 赵颖[1] 吴依兰 刘译升 姚前[1] 张绮婷 郑博[1] 黄琼[1] 刘建仁[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院神经内科,200011

出　　处：《中国临床神经科学》2016年第4期412-417,共6页Chinese Journal of Clinical Neurosciences

基　　金：国家自然科学基金项目(编号:81271302);上海市科委创新行动计划基础研究重点(编号:14JC1404300);上海交通大学医学院-中国科学院神经科学研究所脑疾病临床研究中心2015年率先启动项目(编号:2015NKX006);上海申康医院发展中心临床科技创新项目(编号:SHDC12015310);复旦大学医学生物学国家重点实验室2014年度开放基金课题(编号:SKLMN2014002)

摘　　要：目的探索医疗保险状态对急性缺血性脑卒中(AIS)患者选择静脉内溶栓治疗的影响。方法回顾性收集2012年5月至2016年1月收治的符合静脉内溶栓治疗指征的AIS患者293例,根据患者的医疗保险状态分为医保组256例和非医保组37例,比较两组的临床基线资料,并采用Logistic回归分析医疗保险状态与选择静脉内溶栓治疗的相关因素。结果医保组静脉内溶栓177/256例(69.1%);非医保组静脉内溶栓30/37例(81.1%),两组间比较差异无显著性(P=0.136)。医保组患者年龄更大(P<0.001),合并有高血压病史(P=0.040)、冠心病史(P=0.008)和既往脑卒中史的比例更高(P=0.002),住院天数明显延长(P<0.001),住院总费用增高(P=0.077)。多因素Logistic回归分析提示:高龄(P<0.001)、血脂异常(P=0.005)、入院时美国国立卫生研究院卒中量表(NIHSS)评分高(P<0.001)、发病至来院时间长(P=0.006)是AIS患者选择接受静脉内溶栓治疗的独立预测因素。在接受静脉内溶栓治疗的患者中,医保组与非医保组的溶栓开始时间差异无显著性(P=0.612)。结论年龄轻、高NIHSS评分、发病时间短且伴有血脂异常的AIS患者更倾向于接受静脉内溶栓治疗,是否有医疗保险不影响患者对静脉内溶栓治疗的选择;无论是否有医疗保险,患者接受静脉内溶栓治疗的开始时间相似;有医疗保险患者住院时间更长,住院总费用更高。Aim To investigate the correlation between medicare insurance status and patients＇ decision to receive intravenous thrombolysis（IVT） in acute ischemic stroke（AIS） patients. Methods293 consecutive AIS patients eligible for IVT were enrolled in our hospital from May 2012 to Jan 2016.The patients were divided into a medicare group（256 cases） and a non-medicare（37 cases） group according to their medicare status. Baseline characteristics were analyzed and factors related to patients＇ decision to receive IVT were assessed by univariate and binary Logistic regression. Results The IVT rate was 69.1% for medicare group（177 cases） and 81.1% for non-medicare group（30 cases）. No significant difference was found between the two groups（P=0.136）. Patients in the medicare group were older（P0.001） and more patients had hypertension（P=0.040）, coronary heart disease（P=0.008） and history of stroke（P=0.002）. Patients with medicare had longer hospitalization days（P0.001） and larger total cost（P=0.077）. According to binary Logistic regression, elder（OR=0.953, 95% CI： 0.928~0.978, P0.001）, with dyslipidemia（OR=4.568, 95% CI： 1.588~13.139, P=0.005）, high National Institute of Health Stroke Scale（NIHSS） score（OR=1.400, 95% CI： 1.256~1.561, P0.001） and long symptom onset to hospital time（OR=0.992, 95% CI： 0.986~0.998, P=0.006） were independent factors in receiving IVT. No significant difference was found in door to needle（DTN） time between the medicare group（177 cases） and the non-medicare group（30 cases） in patients who had received IVT（P=0.612）. Conclusion Younger patients with high NIHSS scores, short symptom onset to hospital time and dyslipidemia were more likely to receive IVT while medicare status would not affect patients＇ decision to receive IVT. Whether patients had medicare, DTN time was similar. However, patients with medicare had longer hospitalization days and larger total cost.

关 键 词：医疗保险 缺血性脑卒中 静脉内溶栓 影响因素 

分 类 号：R743[医药卫生—神经病学与精神病学]