头孢菌素类药物皮试结果阳性对患者院内费用和住院时长的影响——一项基于3万名手术患者的真实世界研究  

Influence of positive cephalosporins skin test results on hospital costs and length of stay: a real-world study based on 30 000 surgical patients

作　　者：蒋华玲[1] 冯泽英 朱建平 阳国平[2] JIANG Hua-ling;FENG Ze-ying;ZHU Jian-ping;YANG Guo-ping(Third Xiangya Hospital,Central South University,Hunan Changsha 410013,China;Hunan Creator Information Technology Co.Ltd.,Hunan Changsha 410013,China;不详)

机构地区：[1]中南大学湘雅三医院财务部,湖南长沙410013 [2]中南大学湘雅三医院临床药理中心,湖南长沙410013 [3]湖南科创信息技术股份有限公司,湖南长沙410013

出　　处：《中国医院药学杂志》2022年第11期1156-1159,共4页Chinese Journal of Hospital Pharmacy

基　　金：湖南省科技重点专项(编号:2020SK2010)。

摘　　要：目的:分析头孢菌素类药物皮试结果对手术患者费用的影响,为头孢菌素类药物的皮试管理提供参考。方法:从湖南中南大学湘雅三医院电子病历系统数据中提取2018年1月1日至2020年3月31日住院手术患者数据,根据倾向性评分按照1∶2的比例对头孢皮试结果阳性和阴性患者进行匹配,倾向性评分匹配后使用独立样本t检验比较2组患者药品费用、住院费用和术后住院时长。结果:头孢菌素类药物皮试结果阳性患者药品费用增加1 701.75元(95%CI:-248.91~3 652.40元),住院费用增加3 926.04元(95%CI:-1 680.31~9 532.39元)。在接受四级手术患者中,皮试结果阳性患者药品费用增加6 037.33元(95%CI:941.99~1 1132.67元),住院费用增加10 997.27元(95%CI:-3 686.01~25 680.54元),术后住院天数增加2.17 d(95%CI:0.55~3.80 d)。结论:应将头孢菌素类药物单纯一刀切形式的使用前皮试转变为详细询问过敏史、给药后密切观察、完善急救措施,并健全相关法规,为医生停止进行头孢菌素皮试普遍筛查提供法律保障,抑制医疗费用不合理增长。OBJECTIVE To analyze the effect of cephalosporins skin test results on the cost of surgery patients, and to provide reference for the management of cephalosporins skin test.METHODS The data of inpatients undergoing surgery from January 1, 2018 to March 31, 2020 in Xiangya Third Hospital, Hunan Central South University were extracted from the electronic medical record system. The patients with positive or negative cephalosporins test results were matched in a ratio of 1∶2 according to the propensity score. After matching the propensity score, the independent sample t-test was used to compare the drug costs, hospitalization costs and postoperative hospital stay between the two groups.RESULTS The study found that the drug costs of patients with positive results of cephalosporins skin test increased by 1 701.75 yuan(95% CI:-248.91-3 652.40 yuan), and the hospitalization costs increased by 3 926.04 yuan(95% CI:-1 680.31-9 532.39 yuan). In the patients undergoing stage IV surgery, the drug costs of patients with positive results of cephalosporins skin test increased by 6 037.33 yuan(95% CI: 941.99-11 132.67 yuan), the hospitalization costs increased by 10 997.27 yuan(95% CI:-3 686.01-25 680.54 yuan), and the postoperative hospital stay increased by 2.17 days(95% CI: 0.55-3.80 days).CONCLUSION Based on the empirical analysis, it is proposed that the simple one-size-fits-all form of pre-skin test should be transformed into detailed inquiry of medical history, close observation after administration and improvement of first aid measures, and relevant laws and regulations should be improved in order to provide legal protection for doctors to stop universal cephalosporins skin test and restrain the unreasonable growth of medical expenses.

关 键 词：住院费用 药物皮试 头孢菌素 

分 类 号：R978.1[医药卫生—药品]