CAJ | 학술논문

目的：探讨10960例经皮冠状动脉介入治疗（PCI）发生严重出血患者的相关影响因素及患者的直接医疗费用。方法对在院发生严重出血患者的性别、年龄、抗凝药物联用、急诊 PCI 等相关因素进行单因素方差分析及多因素Logistic回归分析。结果研究结果显示急诊PCI（OR=1.61）、高龄（60～70岁：OR=3.35；70～80岁：OR=6.8；＞80岁：OR=6.7）、多种抗凝药物联用（2种：OR=1.29；3种：OR=2.51）与发生严重出血相关，并且发生严重出血患者与高死亡率相关（OR=19.0）。严重出血组患者的平均治疗费用（112210元对68878元）与平均住院时间（22.2 d对11.7 d）远高于未出血对照组的费用。结论 PCI术前对患者出血风险进行评估，对高出血风险患者采用合理的抗凝药物如比伐芦定，无论患者临床疗效还是经济性均会受益。
목적：탐토10960례경피관상동맥개입치료（PCI）발생엄중출혈환자적상관영향인소급환자적직접의료비용。방법대재원발생엄중출혈환자적성별、년령、항응약물련용、급진 PCI 등상관인소진행단인소방차분석급다인소Logistic회귀분석。결과연구결과현시급진PCI（OR=1.61）、고령（60～70세：OR=3.35；70～80세：OR=6.8；＞80세：OR=6.7）、다충항응약물련용（2충：OR=1.29；3충：OR=2.51）여발생엄중출혈상관，병차발생엄중출혈환자여고사망솔상관（OR=19.0）。엄중출혈조환자적평균치료비용（112210원대68878원）여평균주원시간（22.2 d대11.7 d）원고우미출혈대조조적비용。결론 PCI술전대환자출혈풍험진행평고，대고출혈풍험환자채용합리적항응약물여비벌호정，무론환자림상료효환시경제성균회수익。
Objective To investigate the occurrence of severe bleeding in patients with 10 960 percutaneous coronary intervention(PCI)surgery Retrospective data,to explore the clinical related factors of bleeding and medical cost.Methods Analysis the association with age,mortality and medical cost using one-way analysis of variance and the logistic regression method.Results The results show that the emergency PCI(OR=1.61),age(60 s~70s:OR=3.35;70s~80s:OR=6.8;>80s:OR=6.7),multi~anticoagulants combination(two combinations:OR=1.29; three combin-ations:OR=2.51)have col ations with major bleeding,and patients with major bleeding associated with increased mortality (OR=19.0).Major bleeding increased average medical cost (CNY 112 210 vs.CNY 68 878) and prolonged average hospital stay(22.2d vs.11.7d)compared to the non-hemorrhage group.Conclusion The results reveal that the incorporation of routine individualized bleeding risk estimates into clinical practice, adopting reasonable antico-agulation strategy like bivalirudin in patients at high bleeding risk are likely to get the benefits of both clinical outcome and cost~saving.