摘要
目的探讨非重症社区获得性肺炎(CAP)如何合理利用医疗资源,规范诊治过程。方法选取2009年1—12月1家三甲医院(A市)和2家二甲医院(分别为A市和B市)呼吸内科收治的CAP的病历,回顾性比较患者的肺炎严重指数(PSI)评分、疗效、住院总费用及具体费用构成、住院时间、静脉使用抗生素时间以及初始抗生素是否符合《社区获得性肺炎诊断和治疗指南》。结果共纳入病历251例,B市二甲医院CAP患者的PSI评分高于另外2家医院(P<0.05)。3家医院的治疗有效率、住院时间、静脉使用抗生素时间以及抗生素符合《社区获得性肺炎诊断和治疗指南》的比率差异无统计学意义(P>0.05),而三甲医院的住院费用要明显高于另外2家二甲医院(P<0.05)。三甲医院的化验费和检查费占总费用的比例显著高于2家二甲医院(P<0.05)。结论低级别医院诊治非重症CAP比高级别医院更有利于节约医疗资源。高级别医院用于诊断和鉴别诊断的费用较高,提示通过临床路径规范诊断过程,能够更合理的利用医疗资源,这有待进一步研究。
Objective To explore how to use medical resources more rationally and standardize the diagnosis and treatment of non-severe community-acquired pneumonia （CAP）. Methods Patients with non-severe CAP were collected from the respiratory department of one upper first-class hospital （ in city A） and 2 upper second-class hospitals （ in city A and B） from January to December 2009. We retrospectively reviewed the pulmonary severity index （PSI） scores, efficacy,in-hospital expenses and their constitution, in-hospital time and intravenous use time of antibiotics, and checked whether the initial use of antibiotics was in accordance with the Guidelines on Diagnosis and Treatment of CAP. Results A total of 251 cases were included in this study. The PSI scores of upper second-class hospital in city B were higher than those in the other two hospitals （ P 〈 0. 05 ）. There were no significant differences in treatment efficiency, average in-hospital days, intravenous use time of antibiotics, and the ratio of antibiotics use according with the Guidelines among the three hospitals （ P 〉 0.05 ）. But the hospitalization expenses in the upper first-class hospital were higher than those in the two upper second-class hospitals （ P 〈 0. 05 ）. Further analysis showed that the ratio of total cost of laboratory and physical examination in the upper first-class hospital was significantly higher than that in the two upper second-class hospitals （P 〈 0.05 ）. Conclusion Treatments of non-severe CAP in low-level hospitals can save medical resources. Higher laboratory and physical examination fees in highlevel hospital prompt that we could use medical resources more rationally by standardizing diagnostic process clinically.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2014年第5期480-483,共4页
Chinese Journal of Practical Internal Medicine
关键词
非重症社区获得性肺炎
住院费用
抗生素
不同等级医院
non-severe community-acquired pneumonia
hospitalization expenses
antibiotics
different-level hospital
