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目的探索医疗保险状态对急性缺血性脑卒中(AIS)患者选择静脉内溶栓治疗的影响。方法回顾性收集2012年5月至2016年1月收治的符合静脉内溶栓治疗指征的AIS患者293例,根据患者的医疗保险状态分为医保组256例和非医保组37例,比较两组的临床基线资料,并采用Logistic回归分析医疗保险状态与选择静脉内溶栓治疗的相关因素。结果医保组静脉内溶栓177/256例(69.1%);非医保组静脉内溶栓30/37例(81.1%),两组间比较差异无显著性(P=0.136)。医保组患者年龄更大(P<0.001),合并有高血压病史(P=0.040)、冠心病史(P=0.008)和既往脑卒中史的比例更高(P=0.002),住院天数明显延长(P<0.001),住院总费用增高(P=0.077)。多因素Logistic回归分析提示:高龄(P<0.001)、血脂异常(P=0.005)、入院时美国国立卫生研究院卒中量表(NIHSS)评分高(P<0.001)、发病至来院时间长(P=0.006)是AIS患者选择接受静脉内溶栓治疗的独立预测因素。在接受静脉内溶栓治疗的患者中,医保组与非医保组的溶栓开始时间差异无显著性(P=0.612)。结论年龄轻、高NIHSS评分、发病时间短且伴有血脂异常的AIS患者更倾向于接受静脉内溶栓治疗,是否有医疗保险不影响患者对静脉内溶栓治疗的选择;无论是否有医疗保险,患者接受静脉内溶栓治疗的开始时间相似;有医疗保险患者住院时间更长,住院总费用更高。
Objective To explore the impact of medical insurance on the choice of intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods A retrospective study was conducted on 293 AIS patients who met the indications of intravenous thrombolysis admitted to our hospital from May 2012 to January 2016. According to the medical insurance status of the patients, 256 cases were divided into Medicare group and 37 non-Medicare group, Group of clinical baseline data, and the use of Logistic regression analysis of the status of medical insurance and the choice of intravenous thrombolytic therapy-related factors. Results In the Medicare group, there were 177/256 cases (69.1%) of intravenous thrombolysis and 30/37 (81.1%) cases of intravenous thrombolysis in the non-Medicare group. There was no significant difference between the two groups (P = 0.136). Patients in the Medicare group were older (P <0.001) with a history of hypertension (P = 0.040), a history of coronary heart disease (P = 0.008) and a history of previous strokes (P = 0.002) (P <0.001), and the total cost of hospitalization increased (P = 0.077). Multivariate Logistic regression analysis showed that the NIHSS score (P <0.001) and the hospital admission time (P <0.001) and dyslipidemia (P = 0.005) = 0.006) was an independent predictor of choice of intravenous thrombolysis in AIS patients. Among patients receiving intravenous thrombolysis, there was no significant difference in the initiation of thrombolysis between Medicare and non-Medicare groups (P = 0.612). CONCLUSION: Patients with mild, high NIHSS score, short duration of onset and dyslipidemia are more likely to receive intravenous thrombolysis and whether medical insurance does not influence the choice of intravenous thrombolytic therapy in patients with or without medical insurance , Patients started intravenous thrombolysis similar start time; patients with medical insurance longer hospital stay, higher total cost of hospitalization.