关键词: 急性ST段抬高型心肌梗死, 治疗结果, 卫生资源, 介入治疗, 药物疗法, 临床方案, 影响因素分析

Abstract: Background　In 2012，the World Health Organization announced that ischemic heart disease was the leading cause of death worldwide.In addition，it is also one of the most common causes of death in China.Acute ST-segment elevation myocardial infarction（STEMI） is one of the most common types of ischemic heart disease.Its treatment methods include traditional drug therapy and interventional therapy.However，the quantification of medical resources utilized for both therapy methods has not been elucidated，to some extent，which limits the effective allocation of medical resources.Objective　To investigate the utilization of medical resources of traditional drug therapy and interventional therapy in hospitalized patients with acute STEMI and the related influencing factors.Methods　Patients with acute STEMI admitted for traditional drug therapy or interventional therapy in the Fifth Affiliated Hospital of Sun Yat-Sen University from 10 October，2014 to 31 December，2016 were enrolled by retrospective analysis.The demographic information，disease and treatment characteristics of patients were captured.As traditional drug therapy and interventional therapy were the main predictors，the hospitalization days and the total hospitalization expenses were used as indicators to evaluate the utilization of medical resources and the main influencing factors were analyzed by multivariate linear regression.Results　A total of 315 patients were enrolled，including 67（21.3%） patients in traditional drug therapy group and 248（78.7%） patients in interventional therapy group.There were significant differences between the two groups in age，infarct site，Killip grade，time distribution of SO-to-FMC，admission form，death，CCU or ICU occupancy，total hospitalization expenses，and western charges（P<0.05）．The multifactor linear regression results showed that females（β=4.03），the 50-59 years old（β=3.71），and interventional therapy（β=3.63） were the influencing factors of the increase of length of stay（P<0.05）．Clinical pathway（β=-3.18） and death（β=-4.87） were the influencing factors of the decrease of length of stay（P<0.05）．The 50-59 years old（β=12 483.39），medical insurance（β=7 769.88），interventional therapy（β=36 703.60），and stayed in CCU or ICU before（β=13 539.14） were the influencing factors for the increase of hospitalization expenses，while death（β=-13 347.59） was the influencing factor of the decrease of hospitalization expenses（P<0.05）．Conclusion　The interventional therapy utilizes more medical resources than the traditional drug therapy.Female，the 50-59 years old，and interventional therapy are all correlated to an increased length of stay，while the implementation of clinical pathway can shorten the length of stay.The 50-59 years old，medical insurance and interventional therapy are main influencing factors of the increasing total hospitalization expenses.

Key words: Acute ST-segment elevation myocardial infarction, Treatment outcome, Health resources, Interventional therapy, Drug therapy, Clinical protocols, Root cause analysis