山东省某三甲医院瘢痕子宫产妇再次分娩住院费用及其影响因素

doi:10.6040/j.issn.1671-7554.0.2018.998

摘要/Abstract

摘要： 目的分析山东省某三甲医院瘢痕子宫产妇再次分娩住院费用及其构成,探究住院费用的影响因素。方法选择2014年1月至2016年12月瘢痕子宫再次分娩住院的产妇3 495例,对住院费用及其构成进行描述性分析,对住院费用的影响因素进行单因素分析及多元线性回归分析。结果 2014、2015、2016年瘢痕子宫再次分娩产妇住院费用中位数分别为9 045.7元、9 703.6元和10 612.4元。住院费用构成中,耗材费占比最高,其次为西药费和手术费;总药占比为24.98%,总耗占比为25.84%;产妇年龄、前置胎盘、胎膜早破、妊娠期糖尿病、贫血、分娩方式、抗生素使用和住院天数为住院费用的主要影响因素。结论控制瘢痕子宫产妇再次分娩住院费用,应从积极鼓励瘢痕子宫产妇再次分娩时进行阴道试产、规范抗生素使用、加强高龄产妇孕期保健、缩短住院天数等方面进行综合干预。

关键词: 瘢痕子宫, 再次分娩, 住院费用, 多元线性回归, 二孩政策, 三甲医院

Abstract: Objective To analyze the influencing factors and structural changes of the hospitalization expenses for scar uterine maternal subsequent delivery in a tertiary hospital of Shandong Province. Methods A total of 3 495 cases of hospitalized scar uterine maternal subsequent delivery from January 2014 to December 2016 were collected. Descriptive analysis was conducted on hospitalization expenses and its composition. Univariate analysis and multiple linear regression were applied to analyze its influencing factors. Results The median of hospitalization costs in 2014, 2015 and 2016 were RMB 9 045.7 Yuan, 9 703.6 Yuan and 10 612.4 Yuan, respectively. The medical materials expense accounted for the largest constitution of hospitalization costs, followed by western medication and surgery. The total medicine proportion was 24.98%, and the proportion of medical materials was 25.84%. Gestational age, placenta previa, premature rupture of membranes, gestational diabetes, anemia, delivery mode, antibiotics and hospitalization days were the main influencing factors for hospitalization expenses. Conclusion Comprehensive interventions are needed to control the cost growth by encouraging scar uterine maternal to take vaginal delivery, regulating the use of antibiotics, strengthening prenatal care for elderly pregnancy, so as shortening hospitalization days. 山东大学学报 (医学版)57卷2期 -邵纯纯,等.山东省某三甲医院瘢痕子宫产妇再次分娩住院费用及其影响因素 \=-

Key words: Scar uterus, Subsequent delivery, Hospitalization expenses, Multiple linear regression, Two-child policy, Tertiary hospital

中图分类号:

R197

邵纯纯,张媛,洪凡真,肖娟,刘焕娣,贾红英,张英辉. 山东省某三甲医院瘢痕子宫产妇再次分娩住院费用及其影响因素[J]. 山东大学学报 (医学版), 2019, 57(2): 88-92.

SHAO Chunchun, ZHANG Yuan, HONG Fanzhen, XIAO Juan, LIU Huandi, JIA Hongying, ZHANG Yinghui. Hospitalization expenses and the influencing factors for scar uterine maternal subsequent delivery in a tertiary hospital of Shandong Province[J]. Journal of Shandong University (Health Sciences), 2019, 57(2): 88-92.

参考文献

[1] 翟振武, 赵梦晗. “单独二孩”政策的前因与后果[J]. 人口与计划生育, 2014(3):10-12.
[2] 穆光宗. “全面二孩”政策实施效果和前景[J]. 中国经济报告, 2017(1): 24-26.
[3] 黄群, 林珏莹, 许洪. 二胎政策后经产妇妊娠特征和妊娠结局分析[J]. 内科, 2017, 12(5): 714-715,721.
[4] 周建新, 阮焱. 二孩政策实施前后剖宫产率及剖宫产指征的变化分析[J]. 中国临床医生杂志, 2018, 46(6): 734-737.
[5] 肖琴, 陈秋姿, 郑映雪. “二孩政策”实施后产妇行剖宫产的影响因素分析[J]. 实用预防医学, 2018,25(6):735-737.
[6] 朱振萍, 向思阳, 王琳. 瘢痕子宫再次妊娠严重并发症的危险因素及预防[J]. 浙江临床医学, 2013(1): 102-103.
[7] Carolan M, Frankowska D. Advanced maternal age and adverse perinatal outcome: a review of the evidence [J]. Midwifery, 2011, 27(6):793-801.
[8] Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes [J]. Science, 2014, 345(6198):760-765.
[9] American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics. Practice bulletin No.173: fetal macrosomia [J]. Obstet Gynecol, 2016, 128(5):e195-e209.doi:10.1097/AOG.0000000000001767.
[10] 国务院办公厅. 关于城市公立医院综合改革试点的指导意见(国办发[2015] 38号)[EB/OL].(2015-05-06)[2018-12-25]. http://www.gov.cn/zhengce/content/2015-05/17/content_9776.htm.
[11] 徐敢, 王冲. 药占比在医院管理评价工作中的管制价值和社会效果分析[J]. 中国药房, 2015, 26(34): 4762-4765. XU Gan, WANG Chong. Regulation value and social effect analysis of drug proportion in the hospital management and evaluation [J]. China Pharmacy, 2015, 26(34): 4762-4765.
[12] 吕奕, 郑世锋. 干预前后医院药占比控制情况分析[J]. 医学理论与实践, 2017, 30(11): 1713-1715.
[13] Cunningham FG, Bangdiwala SI, Brown SS, et al. NIH consensus development conference draft statement on vaginal birth after cesarean: new insights [J]. NIH Consens State Sci Statements, 2010, 27(3): 1-42.
[14] 申恒春. 剖宫产术后瘢痕子宫再次妊娠93例分娩方式探讨[J]. 实用妇产科杂志, 2013, 29(3): 234-236.
[15] 孙高高, 昝庆. 疤痕子宫再次分娩方式临床分析[J]. 中外医疗, 2015, 34(3): 22-23.
[16] Fuglenes D, Aas E, Botten G, et al. Why do some pregnant women prefer cesarean? The influence of parity, delivery experiences, and fear [J]. Am J Obstet Gynecol, 2011, 205(1): 45.e1-9.
[17] 余琳, 苏春宏, 王晓怡,等. 剖宫产术后再次妊娠阴道试产的多中心临床研究[J]. 中华妇产科杂志, 2016, 51(8): 581-585. YU Lin, SU Chunhong, WANG Xiaoyi, et al. Multi-centric clinical study of trial of labor after cesarean section [J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51(8): 581-585.
[18] 孙翔. 高龄产妇剖宫产住院日影响因素分析及对策研究[D]. 青岛: 青岛大学, 2013.
[19] 陈子江.“二孩”生育政策后再生育的临床思考[J]. 山东大学学报(医学版), 2017, 55(1):1-4. CHEN Zijiang. Clinical concern of the second pregnancy under the two-child policy [J]. Journal of Shandong University(Health Science), 2017, 55(1):1-4.
[20] 魏维芮. 浅谈我国抗生素的滥用问题及对策[J]. 化工管理, 2018(3): 92,94.
[21] 赵凌波, 孙强, 李成, 等. 山东省农村医疗机构医生抗生素知识与行为[J].山东大学学报(医学版), 2014, 52(2):101-105. ZHAO Lingbo, SUN Qiang, LI Cheng, et al. Antibiotics in rural Shandong Province of China:physicians cognition and behavior [J]. Journal of Shandong University(Health Science), 2014, 52(2): 101-105.
[22] 黎彩虹. 探讨顺产分娩预防应用抗生素的临床应用价值[J]. 特别健康, 2017(17): 43.
[23] 黄修治. 顺产分娩预防应用抗生素的临床应用价值[J]. 中国实用医药, 2015, 10(15): 173-174,175.
[24] 李永明. 计划性剖宫产用药24小时预防感染60例临床分析[J]. 吉林医学, 2014, 35(35): 7865-7866.
[25] 郑丽萍, 魏方方, 李敏. 剖宫产围手术期预防性抗生素使用的临床分析[J]. 生殖医学杂志, 2017, 26(4): 374-376.
[26] 张川, 刘兴会, 张伶俐. 产科抗生素合理预防使用: 基于加拿大和美国产科手术抗生素合理使用指南解读[J]. 中国实用妇科与产科杂志, 2012, 28(7): 485-487. ZHANG Chuan, LIU Xinghui, ZHANG Lingli. Antibiotic prophylaxis for gynecologic procedures: The interpretation of guidelines of Canada and the United States obstetric surgery rational use of antibiotics [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2012, 28(7): 485-487.
[27] 夏军芳, 曹秀玲, 徐凌忠, 等. 山东省某医院剖宫产住院费用变化及影响因素分析[J]. 中国卫生经济, 2015, 34(7): 68-70. XIA Junfang, CAO Xiuling, XU Lingzhong, et al. Study on changes and influencing factors of cesarean hospitalization expense in a hospital of Shandong [J]. Chinese Health Economics, 2015, 34(7): 68-70.

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