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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 CAP should make rational use of medical resources and standardize the diagnosis and treatment of non-severe community acquired pneumonia (CAP). Methods The medical records of CAP in respiratory medicine from 1 top three hospitals (A city) and 2 top 2 hospitals (cities A and B, respectively) from January to December in 2009 were retrospectively analyzed. The patients’ pneumonia severity index (PSI) Score, efficacy, total cost of hospitalization and specific costs, length of stay, time of intravenous antibiotic use, and initial antibiotic compliance with the Guide to Diagnosis and Treatment of Community Acquired Pneumonia. Results A total of 251 cases were included in the medical records. The PSI scores of CAP patients in the B hospitals in B city were higher than those in the other 2 hospitals (P <0.05). There was no significant difference in the rates of treatment, length of stay, duration of intravenous antibiotics, and antibiotics in the guidelines for the diagnosis and treatment of community-acquired pneumonia in the three hospitals (P> 0.05), while hospital charges for the top three hospitals were significantly higher In two other two hospitals (P <0.05). The ratio of laboratory and examination fees to the total cost of the top three hospitals was significantly higher than that of the two top two hospitals (P <0.05). Conclusion The diagnosis and treatment of non-severe CAP in lower-level hospitals are more conducive to saving medical resources than high-level hospitals. High-level hospitals for the diagnosis and differential diagnosis of high cost, suggesting that through the clinical pathway to standardize the diagnosis process, to make more rational use of medical resources, which needs further study.