四川省双流县永安中心卫生院2009年度住院疾病构成与用药情况现状调查

目的调查四川省双流县永安中心卫生院2009年度住院疾病构成与用药情况,为进一步研究提供基线数据。方法采取问卷调查结合专题访谈,收集该院2009年度住院病历和用药记录,按国际疾病分类（ICD-10）标准对出院记录的第一诊断进行分类,并按剂型、药理作用、金额、住院科室整理、分析住院药品使用情况。内容包括住院患者一般信息、出院诊断名、住院费用、所用药品金额等,应用Excel软件进行数据整理和统计分析。结果①该院2009年度住院病例共4335人次,女性多于男性（55.59%vs.44.1%）,住院病例疾病谱分为18类,占ICD-10标准分类的85%。②前5位系统疾病分别是呼吸系统疾患、消化系统疾患、泌尿生殖系统疾患、损伤与中毒、妊娠分娩和产褥期疾患,共3531人次,占总住院人次的81.45%。其中,除损伤与中毒外,其余4位系统疾患的住院病人均为女性多于男性。③前15位单病种依次为：慢支炎急发、上呼吸道感染、急性支气管炎、肺炎、急性胃肠炎、慢性支气管炎、泌尿道结石、急性阑尾炎、慢性胃炎、急性胃炎、椎基底动脉供血不足、剖宫产、骨折、急性荨麻疹和梅尼埃病。④前15位单病种患者构成累计达59.81%,包括6种慢性疾病,9种急性疾病,住院人次数构成比分别为21.81%和38%,慢性病的各项平均费用均高于急性病。⑤西药金额构成比占80%～90%,抗微生物类药物和调节水、电解质类药物在内儿科、外妇科按金额排序均排名前2位。结论①2009年该院住院病例总体疾病负担主要集中在25～59岁和60岁及以上的两个年龄段,主要是呼吸和消化系统疾病,且以急性病为主。②2009年度永安中心卫生院住院部常见疾病除肺炎、泌尿道结石、尿潴留、中毒与损伤及脑梗塞男多于女外,其余疾病均为女多于男。③2009年度该院育龄住院人员剖宫产者为顺产者的4.24倍,其合理性值得关注。④按金额排位,常用药物涉及4类药和1类疫苗,与主要疾病负担一致。⑤应重点监管乡院用药金额高或频度大的药物及其合理使用。⑥2009版国家基本药物目录中0.9%氯化钠注射液、5%葡萄糖注射液、头孢呋辛等药物符合该院住院患者治疗需要。

A Status Survey on Disease Constitution and Drug Application of Inpatients in Yong'an Central Township Health Center in Shuangliu County of Sichuan Province in 2009

Objective To investigate the disease constitution and drug application of inpatients in Yong＇an Central Township Health Center（YaC） in Shuangliu County of Sichuan province in 2009,so as to provide baseline data for further research.Method Questionnaire and focus interview were carried out,case records and drug application information of YaC inpatients in 2009 were collected.The diseases were classified according to ICD-10 based on first diagnose.Drug application was analyzed based on pharmaceutical dosage form,pharmaceutical effect,cost,and clinical departments.Data including general information of the inpatients,discharge diagnosis,hospitalization expenses,and drug cost etc.were rearranged and analyzed by Excel software.Result a） The total number of inpatients was 4 335 and the female/male was 55.59% vs.44.1%,their disease spectrum included 18 categories,which accounted for 85% of disease classes of ICD-10;b） The inpatients suffered from top 5 systematic diseases were 3 531,accounted for 81.45%,which included the respiratory,digestive,urinary tract and urogenital,circulatory systems,as well as trauma and toxicosis.Except the trauma and toxicosis,the female was more than the male in all the rest main systematic diseases;c） The top 15 single diseases were chronic bronchitis in acute stage,acute upper respiratory infection,pneumonia,acute gastroenteritis,chronic bronchitis,urinary stone,acute appendicitis,chronic gastritis,acute gastritis,vertebrobasilar ischemia,cesarean section,fracture,acute urticaria,and meniere disease;d） The total inpatients with top 15 single diseases accounted for 59.81%,including 6 chronic diseases and 9 acute diseases.The patients＇ average costs of chronic disease were higher than that of acute disease;and e） The proportion of western medicine cost accounted for 80% to 90% of total cost,and the cost of anti-microbial drugs and drugs of humoral regulation ranked as the top two.Conclusion a） The inpatients in 2009 are mainly in age of 25 to 59,and over 60 years old as well.The top two diseases mainly attacked are in respiratory and digestive systems,acute diseases are more than the chronic;b） Except for pneumonia,urinary stone,uroschesis,urinary stone,trauma,and toxicosis,the female inpatients are more than the male for complaining all other diseases;c） The number of inpatients received hysterotomy is as 4.24 times as that of natural labor,and the rationality should be paid attention to;d） The commonly used drugs,according to the costs,involve in 4 kinds of drugs and 1 kind of vaccine,which are in accordance with the main burden of the diseases;e） Supervision should be focused on the drugs of high cost or the one most frequently used;and f） The 0.9% Sodium chloride injection,Glucose injection and Cefuroxime listed in the EML（2009） satisfy the needs of treatment for YaC inpatients in 2009.