目的 分析辽西地区不同医疗保险对急性ST段抬高型心肌梗死(STEMI)患者救治情况及短期预后的影响.方法 采用前瞻性研究连续入选2014年1月~2016年12月因胸痛就诊于辽西地区(阜新市中心医院、北票市中心医院)的STEMI患者635例,剔除不符合要求患者64例,共纳入571例.将设计好的病例报告表发放至当地医院,由经过培训的医生填表,本中心进行质量控制.根据患者的医保情况分为农村医疗合作组(121例)、城镇居民医保组(198例)、城镇职工医保组(138例)和自费组(114例).详细记录四组患者的临床资料、静脉溶栓情况、经皮冠状动脉介入治疗(PCI)、平均住院总费用、住院期间主要不良心血管事件(MACE)及出院1个月内MACE发生率和规律使用二级预防用药情况.结果 本研究共纳入571例辽西地区STEMI患者,总体静脉溶栓比例为1.3%(7/571),PCI的比例为14.4%(82/571),患者平均住院费用(13313.3±4274.5)元,住院期间MACE为12.6%(72/571),出院后1个月内规律使用二级预防用药比例为53.6%(306/571),出院后1个月内MACE发生率为11.0% (63/571).农村医疗合作、城镇居民医保、城镇职工医保以及自费的患者出院1个月内规律用药的比例分别为43.8%、54.0%、67.4%、46.5%,接受PCI的比例分别为10.7%、19.7%、15.2%以及7.9%;住院总费用分别为(12908.3±3859.3)元、(13328.7±4392.4)元、(16987.3±4972.6)元、(10028.7± 3873.8)元,四组比较,差异有统计学意义(P均<0.05).结论 辽西地区STEMI患者再灌注治疗比例较低,出院后1个月内规范使用二级预防用药比例较低,特别是农村医疗合作和自费患者.应积极建设完善合理的医疗保险体系.
Objective To analyze the influence of different types of medical insurance on treatment and short-term prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) in western part of Liaoning Province. Methods STEMI patients (n=635, and after eliminated 64 unqualified patients, n=571) were chosen continuously by using prospective study from western part of Liaoning Province (Central Hospital of Fuxin City and Central Hospital of Beipiao City) from Jan. 2014 to Dec. 2016. The designed tables of case report were delivered to local hospitals and filled by trained doctors. The quality control was carried out by Treatment Center for Cardiovascular Diseases of People's Hospital of China Medical University. The patients were divided, according to their types of medical insurance, into rural cooperative medical insurance group (RCMI group, n=121), urban residents' medical basic insurance group (URMBI group, n=198), medical insurance for urban workers group (MIUW group, n=138) and self-paying group (n=114). The clinical materials, intravenous thrombolysis, PCI, average total in-patient cost, incidence of major adverse cardiovascular events (MACE) during hospitalization and within 1 month after discharged, and regular administration of secondary preventive drugs were recorded in detail in 4 groups. Results There were totally 571 patients with STEMI included in the study. The percentage of patients with intravenous thrombolysis was 1.3% (7/571), that of patients received PCI, 14.4% (82/571), average in-patient cost was (13 313.3±4274.5) RMB, incidence of MACE was 12.6% (72/571) during hospitalization, percentage of patients with regular administration of secondary preventive drugs was 53.6% (306/571) within 1 month after discharged, and incidence of MACE was 11.0% (63/571) within 1 month after discharged. The percentage of patients with regular administration of secondary preventive drugs was 43.8% in RCMI group, 54.0% in URMBI group, 67.4% in MIUW group and 46.5% in self-paying group. The percentage of patients received PCI was 10.7% in RCMI group, 19.7% in URMBI group, 15.2% in MIUW group and 7.9% in self-paying group. The total in-patient cost was (12 908.3±3859.3) RMB in RCMI group, (13 328.7±4392.4) RMB in URMBI group, (16 987.3 ±4972.6) RMB in MIUW group and (10 028.7±3873.8) RMB in self-paying group. The comparison among 4 groups had statistical significance (all P<0.05). Conclusion The percentage of STEMI patients with reperfusion treatment is lower in western part of Liaoning Province, and that of patients with regular administration of secondary preventive drugs was lower too, especially in RCMI group and self-paying group. A perfect and reasonable medical insurance system should be constructed actively.