高血糖对急诊患者住院费用、预后的影响

Effects of hyperglycemia in emergency department on medical cost and disease prognosis

摘要:

目的 探讨急诊就诊时血糖水平与患者住院时间、医疗费用及预后的相关性。方法 选取2015 年 2 月1 日—2015 年7 月31 日于南京医科大学附属无锡人民医院急诊就诊并收住入院的患者6 151 例，根据 随机血糖是否≥ 7.8 mmol/L 将患者分为血糖正常组与高血糖组；根据患者平均总医疗费用（19 905.90± 325.71）元分为高费用组与低费用组。高血糖组患者根据入院前有无降糖治疗，分为治疗组与未治疗组。607 例患者有降糖治疗记录，根据随机血糖是否≥ 7.8 mmol/L 分为降糖后高血糖组和降糖后血糖正常组，分别为 350 和257 例。对各组患者临床资料进行分析。结果 高血糖组年龄、住院时间、总医疗费用、检查费及药 费均高于血糖正常组（P <0.05）。高费用组年龄、随机血糖及住院时间均高于低费用组（P <0.05）。Logistic 回归分析发现，住院时间、随机血糖、年龄、转科治疗及抢救是住院费用的影响因素（P <0.05）。治疗组年龄、 住院时间、随机血糖及检查费均高于未治疗组（P <0.05）。降糖后高血糖组随机血糖、总医疗费用均高于降 糖后血糖正常组（P <0.05）。结论 多科协作有利于优化高血糖患者急危重状态的治疗及经济成本，同时需 加强全社会血糖筛查，指导血糖控制，在源头减少高血糖对应激状态患者的影响。

Abstract:

Objective To explore the relationship of admission blood glucose levels in the emergency department with hospitalization time, medical cost and disease prognosis. Methods Totally 6151 patients were collected from 01/02/2015 to 31/07/2015 in the emergency department of Wuxi People’s Hospital, divided into hyperglycemia group and normal blood glucose group according to random blood glucose ≥7.8mmol/L and divided into high cost group and low cost group according to the average of total medical cost 19905 Yuan RMB. Results Patients with hyperglycemia had significant older age, longer hospitalization, higher medical cost and higher rates of rescue than patients in normal blood glucose group (P < 0.05). Patients with high cost had higher blood glucose level, older age, longer hospitalization than patients with low cost (P < 0.05). The risk factors of hospitalization expenses included hospitalization time, random blood glucose level, age, department transference and rescue (P < 0.05). The average age, median of hospitalization time and the rate of readmission of hyperglycemia group with diabetic therapy before admission was higher than those of patients without diabetic therapy (P < 0.05).Patients with hyperglycemia who had high blood glucose after treatment had more medical cost and higher rate of rescue than those with normal blood glucose after treatment (P < 0.05). Conclusions Multidisciplinary collaboration is conducive to optimizing the treatment and economic cost of critical state of patients with hyperglycemia. At the same time, it is necessary to strengthen the whole society blood sugar screening, guide blood sugar control, and reduce the impact of hyperglycemia on stress state patients at the source.