北京市西城区急性冠脉综合征患者住院时间分析  

Analysis on the length of stay of inpatients with acute coronary syndrome in Xicheng District of Beijing

作　　者：杨玲[1] 杜雪平[1] YANG Ling;DU Xue-ping(Yuetan Community Health Service Center Fu Xing Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属复兴医院月坛社区卫生服务中心,北京100045

出　　处：《中华全科医学》2021年第11期1855-1857,共3页Chinese Journal of General Practice

基　　金：首都卫生发展科研专项(首发2018-3-7023)。

摘　　要：目的分析北京市西城区急性冠脉综合征(ACS)患者住院时间在不同人群中的分布特点、变化趋势及影响因素。方法采用整群抽样的方法,于北京市卫健委信息中心搜索西城区2012年1月1日—2016年12月31日住院病历病案首页,再根据国际疾病分类(ICD)的ICD-10编码搜索"I20.--;I21.--;I22.--;I23.--;I24.--;I25.--"6大条目下所有子条目,包含关键词"冠状动脉粥样硬化性心脏病""心绞痛""心肌梗死",经过户籍地址整理、重报病例排查和数据完整性与准确性的审核,筛选ACS患者住院31 448例次。采用SPSS 25.0统计学软件对数据进行分析处理。计量资料不符合正态分布,以M(P_(25),P_(75))表示,计数资料以实际数目和百分数(%)统计描述,采用多因素logistic回归分析方法住院时间的影响因素。结果 ACS患者住院时间中位数为8.00 d,随年龄增长,住院时间延长。非三级医院住院时间中位数为12.00 d,三级医院住院时间中位数为8.00 d。59.09%(13 710/23 202)的不稳定性心绞痛(UA)患者住院时间<10 d, 72.88%(2 819/3 868)的非ST段抬高型心肌梗死(NSTEMI)患者住院时间≤14 d, 77.09%(3 375/4 378)的ST段抬高型心肌梗死(STEMI)患者住院时间≤14 d。经多因素logistic分析,医院级别、住院次数、年龄、ACS诊断分型、费用类别、介入诊疗、急诊入院、性别、住院费用是影响住院时间的因素(均P<0.001)。结论仍有部分ACS患者住院时间超过临床路径建议的标准,尤其是UA患者;非三级医院平均住院时间大于三级医院,一二级医院需进一步规范并提高ACS诊疗技术,同时对其开展冠心病二级预防/心脏康复,减少反复住院,有助于缩短住院时间。Objective To analyse the distribution characteristics in different populations,change tendency and influencing factors of length of stay(LOS)of patients with acute coronary syndrome(ACS)in Xicheng District,Beijing.Methods Cluster sampling was carried out.A total of 31448 ACS inpatients were screened in Beijing Municipal Health Information Center by searching the medical records of Xicheng District,Beijing between 2012.1.1 and 2016.12.31,and then all sub-items under the six major items"I20.--;I21.--;I22.--;I23.--;I24.--;I25.--"were searched according to the International Classification of Diseases(ICD)-10 codes including the keywords"coronary atherosclerosis heart disease","angina"and"myocardial infarction",after sorting out the household address,rereporting cases screening and reviewing the data integrity and accuracy.SPSS 25 software was used to analyse the data.Measurement data were represented by M(P_(25),P_(75)).Counting data were statistically described by the actual number and percentage(%),and multivariate logistic analysis was used to analyse the influencing factors of LOS.Results The median LOS of ACS patients was 8 days,which increased with age.The median LOS in non-tertiary hospitals was 12 days,whilst that in tertiary hospitals was 8 days.The LOS of 59.09%(13710/23202)of patients with unstable angina(UA),72.88%(2819/3868)of patients with non-ST-elevation myocardial infarction and 77.09%(3375/4378)of patients with ST-elevation myocardial infarction were<10,<14 and<14 days,respectively.According to multivariate logistic analysis,hospital level,hospitalisation frequency,age,ACS diagnostic classification,cost category,interventional diagnosis and treatment,emergency admission,gender and hospitalisation cost were the factors that affected the LOS(all P<0.001).Conclusion There are still some ACS patients whose LOS exceeds the standard recommended by the clinical pathway,especially UA patients.The average LOS in non-tertiary hospitals is greater than that in tertiary hospitals.Primary and secondary hospitals

关 键 词：急性冠脉综合征 住院时间 多因素分析 

分 类 号：R543.3[医药卫生—心血管疾病]