成都市某医院上消化道出血住院患者病例特征及治疗费用分析

目的 分析上消化道出血（UGIB）住院患者病例特征及治疗费用情况,为制定预防控制政策及措施、改善治疗手段、提高患者预后及指导医疗系统统筹疾病费用等提供依据。方法 从医院信息管理系统中搜索2019年成都市某三甲医院全年收治的所有初诊UGIB住院病例,对病历资料及治疗费用进行描述分析。结果 共纳入符合研究标准的UGIB住院病例308例。24~59岁144例（中青年组）,平均年龄（42.05 ± 7.54）岁,男性占70.14%。60~88岁164例（老年组）,平均年龄（73.54 ± 6.05）岁,男性占82.83%。2组病例的性别和BMI分布差异均无统计学意义（均P>0.05）。2组病例间非甾体抗炎药服用史、高血压病史、糖尿病史、冠心病史、脑卒中病史、慢性阻塞性肺疾病病史及伴随≥2种合并症者构成分布差异均有统计学意义（P<0.05或P<0.01）。UGIB患者临床表现主要以黑便（占57.14%）、上腹痛（占35.39%）、呕血（占27.60%）为主,出血病因主要为十二指肠溃疡（占34.74%）、胃溃疡（占20.78%）、胃十二指肠炎（占11.36%）。上腹痛比例中青年组高于老年组,外周循环障碍低于老年组 （均P<0.01）。出血病因中中青年组十二指肠溃疡、食管胃底静脉曲张比例高于老年组,胃溃疡、复合溃疡、胃癌比例低于老年组 （P<0.01或P<0.05）。中青年组住院时间中位数为12.40（6.16,25.51）d,老年组为16.21（6.35,25.54） d;中青年组治疗费用平均为（12 783.6 ± 1 743.1）元,老年组平均为（21 785.6 ± 2 762.3）;老年组的西药费、中成药费、输血费、检查费、手术费、总费用及住院时间均较高（P<0.05或<0.01）。结论 UGIB住院患者以男性为主,不同年龄段UGIB住院患者临床表现及出血病因有差异,老年UGIB患者治疗时间及费用显著高于中青年组。

Case characteristics and treatment costs of upper gastrointestinal hemorrhage in a hospital in Chengdu City

Objective To analyze the characteristics and treatment costs of inpatients with upper gastrointestinal hemorrhage （UGIB）, so as to provide basis for formulating prevention and control policies and measures, improving treatment methods, improving the prognosis of patients and guiding the medical system to coordinate the disease cost. Methods All the newly diagnosed UGIB inpatients in a hospital in Chengdu City in 2019 were searched from the hospital information management system, and the medical records and treatment costs were analyzed. Results A total of 308 UGIB inpatients were included. Among them, 144 cases were aged from 24 to 59 years （young and middle-aged group）, with an average age of （42.05 ± 7.54） years,and male accounted for 70.14%. 164 cases were aged from 60 to 88 years （elderly group）, with an average age of （73.54 ± 6.05） years,and male accounted for 82.83%. There were statistically significant differences between the two groups in the history of NSAIDs, hypertension, diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, and more than two complications （P<0.05 or P<0.01）. The main clinical manifestations of UGIB patients were melena （57.14%）, epigastric pain （35.39%） and hematemesis （27.60%）. The main causes of bleeding were duodenal ulcer （34.74%）, gastric ulcer （20.78%）, gastroduodenitis （11.36%）. The proportion of epigastric pain in the young and middle-aged group was higher than the elderly group, and the peripheral circulation disorder was lower than the elderly group （all P<0.01）. The proportion of duodenal ulcer, esophageal and gastric varices in the young and middle-aged group was higher than the elderly group, and the proportion of gastric ulcer, compound ulcer and gastric cancer was lower than the elderly group （P<0.01 or P<0.05）. The median length of stay was 12.40 （6.16, 25.51） days in the young and middle-aged group, and 16.21 （6.35, 25.54） days in the elderly group. The average treatment costs was （12 783.6 ± 1 743.1） yuan in the young and middle-aged group, and （21 785.6 ± 2 762.3） in the elderly group. The cost of Western medicine, Chinese patent medicine, blood transfusion, examination, operation, total cost and length of stay in the elderly group were higher than the young and middle-aged group （P<0.05 or P<0.01）. Conclusion UGIB inpatients are mainly male. The clinical manifestations and hemorrhagic causes of UGIB patients in different age groups are different. The treatment time and cost of elderly UGIB patients are significantly higher than that of young and middle-aged groups.