CAJ | 학술논문

目的：通过总结、分析颅脑外伤合并多发伤患者的临床资料，评估颅脑外伤合并多发伤患者发生高额住院费用的危险因素。方法：回顾性分析我院颅脑外伤合并多发伤患者的临床资料，查询住院费用，通过卡方检验筛选发生高额费用的危险因素，经多因素Logistic回归分析确定独立危险因素。结果：出院结算时发生高额费用90例（35.29%）。Pearson卡方检验显示入院时AIS-ISS评分、GCS评分、全身麻醉手术治疗、机械通气、肺部感染、泌尿系感染、腹泻、吸烟史等因素与发生高额费用相关性差异有统计学意义(P＜0.05)，Logistic回归多因素分析显示入院时AIS-ISS评分、全身麻醉手术治疗、肺部感染、泌尿系感染、吸烟史等因素为颅脑外伤合并多发伤患者发生高额费用的独立危险因素。结论：对于颅脑外伤合并多发伤患者，应在全面评估伤情基础上明确手术指征，并且积极预防感染，从而降低患者发生高额医疗费用的风险。
목적：통과총결、분석로뇌외상합병다발상환자적림상자료，평고로뇌외상합병다발상환자발생고액주원비용적위험인소。방법：회고성분석아원로뇌외상합병다발상환자적림상자료，사순주원비용，통과잡방검험사선발생고액비용적위험인소，경다인소Logistic회귀분석학정독립위험인소。결과：출원결산시발생고액비용90례（35.29%）。Pearson잡방검험현시입원시AIS-ISS평분、GCS평분、전신마취수술치료、궤계통기、폐부감염、비뇨계감염、복사、흡연사등인소여발생고액비용상관성차이유통계학의의(P＜0.05)，Logistic회귀다인소분석현시입원시AIS-ISS평분、전신마취수술치료、폐부감염、비뇨계감염、흡연사등인소위로뇌외상합병다발상환자발생고액비용적독립위험인소。결론：대우로뇌외상합병다발상환자，응재전면평고상정기출상명학수술지정，병차적겁예방감염，종이강저환자발생고액의료비용적풍험。
To summarize the clinical parameters of patients with traumatic brain injury combined multiple trauma and evaluate risk factors of high cost in hospital. Methods: The clinical data of patients suffering traumatic brain injury combined multiple trauma in our institution were analyzed retrospectively. Chi-square test was used to select risk factors for high cost. Non-condition logistic regression analysis was used to define the independent risk factors. Results: There were 90 (35.29%) cases with high cost at discharge. Factors including AIS-ISS and GCS score on admission, operation under general anesthesia, mechanical ventilation, peumonia, urinary infections, diarrhea and smoking were revealed as the factors significantly related to high cost by Pearson chi-square test. Then, AIS-ISS score on admission (OR=15.842, 95%CI 4.375-57.355,P<0.01), operation under general anesthesia (OR=7.946,95%CI 2.262-27.919,P<0.01), pneumonia (OR=28.552,95%CI 8.771-92.943,P<0.01), urinary infections (OR=3.690,95%CI 1.225-11.119,P<0.05)and smoking (OR=3.970,95%CI 1.334-11.819,P<0.05)were shown as independent risk factors were shown as statistical significance by the non-condition logistic regression analysis. Conclusion Reasonable operation under the comprehensive evaluation of injure, active prevention of infection for patients with traumatic brain injury combined multiple traumas play important role in decreasing the risk of high cost in hospital.