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Value of Huaxi Emotional-distress Index for Evaluating the Length of Hospital Stay, Hospitalization Costs, and Patient Satisfaction in Elderly Patients after Surgery
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摘要:
目的 探讨华西心晴指数(Huaxi emotional-distress index, HEI)对老年手术患者住院时间、住院费用及满意度的评估价值。 方法 回顾性收集并分析四川大学华西医院麻醉科老年患者数据库2015年10月至2018年6月间患者的临床资料, 包括性别、年龄、文化程度、美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级、是否为恶性肿瘤、手术科室、术前简易智力状态评估量表Mini-cog评分、Katz指数、HEI分级(1~4级)及不良情绪等观察指标, 分析HEI与住院时间、住院费用、患者满意度的相关性。 结果 共入选565例符合纳入和排除标准的老年患者, 性别、年龄、文化程度、ASA分级、是否为恶性肿瘤、手术科室、Mini-cog评分等在HEI不同分级之间及有/无不良情绪两组间的差异均无统计学意义(P均>0.05)。不良情绪组患者的住院时间更长(P=0.003)、日均住院费用更高(P=0.001), 且HEI分级越高住院时间越长(P=0.000)。HEI分级和有/无不良情绪均与术后第7 d患者满意度相关(P均 < 0.05), 有不良情绪组术后7 d满意度更低。 结论 HEI可较好预测老年手术患者的住院时间、日均住院费用及患者满意度。 Abstract:Objective The aim of this study was to evaluate the value of Huaxi emotional-distress index(HEI) on assessing the length of hospital stay, hospitalization costs, and patient satisfaction in elderly patients after surgery. Methods The clinical data of elderly patients in the surgery database from the Department of Anesthesiology, West China Hospital of Sichuan University during October 2015 and June 2018 were retrospectively collected, including gender, age, education, American Society of Anesthesiologists(ASA) classification, malignancy, the surgical department, Mini-cog score, Katz index, HEI classes(1-4), and adverse emotion, to analyze the correlation of HEI with length of hospital stay, hospitalization costs, and patient satisfaction. Results A total of 565 elderly patients meeting the inclusive and exclusive criteria were enrolled in this study. There were no statistical difference in gender, age, education, ASA classification, malignancy, the surgical department, and Mini-cog score among different HEI classes and different adverse emotion groups(all P>0.05). The patients with adverse emotion had longer length of hospital stay(P=0.003) and higheraverage daily hospitalization costs(P=0.001); and the higher the HEI rating, the longer the length of hospital stay(P=0.000). HEI and adverse emotion correlated with the 7-day patient satisfaction(all P < 0.05), the patients with adverse emotion had lower 7-day patient satisfaction. Conclusion HEI might predict the length of hospital stay, hospitalization costs, and patient satisfaction in elderly patients after surgery. -
Key words:
- Huaxi emotional-distress index /
- elderly /
- prediction
利益冲突 无 -
表 1 华西心晴指数量表[7]
评估项目 评估标准 完全没有
（0分）偶尔
（1分）一部分时间
（2分）大部分时间
（3分）全部时间
（4分）1.您有多少时候情绪低落到无论怎样都无法开心？ 2.您有多少时候会感到对什么事情都没有兴趣? 3.您有多少时候会感到过于紧张? 4.您有多少时候会感到控制不住地担忧或担心? 5.您有多少时候会感到不安以致难以平静下来? 6.您有多少时候会感到害怕再次突然出现严重恐惧或惊恐感? 7.您有多少时候会感到经常责怪自己? 8.您有多少时候会感到没有希望? 9.您有多少时候会感到活着没意思? 10.您的不良情绪对您生活的影响有多大? 11.导致您出现各种上述情绪的原因是什么？ 总分 
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表 2 565例老年手术患者一般临床资料及不同华西心晴指数分级比较
指标 总体 华西心情指数分级 1级(n=540) 2级(n=14) 3级(n=7) 4级(n=4) P值 年龄[M(P25, P75), 岁] 71(69, 74) 71(68, 74) 71.5(69, 76) 71(66, 76) 71.5(69, 74) 0.850 年龄分层[n(%)] 0.798 65~69岁 236(41.8) 228(42.2) 4(28.6) 3(42.9) 1(25.0) 70~79岁 287(50.8) 272(50.4) 9(64.3) 3(42.9) 3(75.0) ≥80岁 42(7.4) 40(7.4) 1(7.1) 1(14.2) 0(0) 女性[n(%)] 194(34.3) 182(33.7) 6(42.9) 4(57.1) 2(50.0) 0.459 高中及以上文化程度[n(%)] 162(28.7) 154(28.5) 4(28.6) 3(42.9) 1(25.0) 0.868 Mini-cog评分[M(P25, P75)] 3.0(2.0, 4.0) 3.0(2.0, 4.0) 2.5(2.0, 3.5) 3.0(2.0, 3.0) 2.5(2.0, 3.7) 0.738 Mini-cog评分分级[n(%)] 0.588 ＜3分 200(35.4) 188(34.8) 7(50.0) 3(42.9) 2(50.0) ≥3分 365(64.6) 352(65.2) 7(50.0) 4(57.1) 2(50.0) Katz指数分级[n(%)] 0.037 ＜6分 4(0.7) 3(0.6) 1(7.1) 0(0) 0(0) 6分 561(99.3) 537(99.4) 13(92.9) 7(100.0) 4(100.0) 恶性肿瘤[n(%)] 527(93.3) 504(93.3) 13(92.9) 6(85.7) 4(100.0) 0.818 ASA分级[n(%)] 0.581 1级 2(0.4) 2(0.4) 0(0) 0(0) 0(0) 2级 413(73.1) 393(72.8) 10(71.4) 6(85.7) 4(100.0) 3级 149(26.3) 144(26.6) 4(28.6) 1(14.3) 0(0) 4级 1(0.2) 1(0.2) 0(0) 0(0) 0(0) 手术科室[n(%)] 0.491 肝胆胰外科 226(40.0) 212(39.3) 7(50.0) 5(71.4) 2(50.0) 胃肠外科 289(51.1) 279(51.7) 6(42.9) 2(28.6) 2(50.0) 血管外科 5(0.9) 4(0.7) 1(7.1) 0(0) 0(0) 骨科 6(1.1) 6(1.1) 0(0) 0(0) 0(0) 泌尿外科 39(6.9) 39(7.2) 0(0) 0(0) 0(0) ASA：美国麻醉医师协会
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表 3 565例老年手术患者一般临床资料及不良情绪分组比较
指标 总体 无不良情绪(n=540) 有不良情绪(n=25) P值 年龄[M(P25, P75), 岁] 71(69, 74) 71(68, 74) 71(69, 75) 0.441 年龄分层[n(%)] 0.348 65~69岁 236(41.8) 228(42.2) 8(32.0) 70~79岁 287(50.8) 272(50.4) 15(60.0) ≥80岁 42(7.4) 40(7.4) 2(8.0) 女性[n(%)] 194(34.3) 182(33.7) 12(48.0) 0.141 高中及以上文化程度 162(28.7) 154(28.5) 8(32.0) 0.707 Mini-cog评分[M(P25, P75)] 3.0(2.0, 4.0) 3.0(2.0, 4.0) 3.0(2.0, 3.0) 0.262 Mini-cog评分分级[n(%)] 0.178 ＜3分 200(35.4) 188(34.8) 12(48.0) ≥3分 365(64.6) 352(65.2) 13(52.0) Katz指数分级[n(%)] 0.431 ＜6分 4(0.7) 3(0.6) 1(4.0) 6分 561(99.3) 537(99.4) 24(96.0) 恶性肿瘤[n(%)] 527(93.3) 504(93.3) 23(92.0) 0.795 ASA分级[n(%)] 0.468 1级 2(0.4) 2(0.4) 0(0) 2级 413(73.1) 393(72.8) 20(80.0) 3级 149(26.3) 144(26.6) 5(20.0) 4级 1(0.2) 1(0.2) 0(0) 手术科室[n(%)] 0.286 肝胆胰外科 226(40.0) 212(39.3) 14(56.0) 胃肠外科 289(51.1) 279(51.7) 10(40.0) 血管外科 5(0.9) 4(0.7) 1(4.0) 骨科 6(1.1) 6(1.1) 0(0) 泌尿外科 39(6.9) 39(7.2) 0(0) ASA:同表 2
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表 4 不同华西心晴指数分级的患者满意度M(P25, P75)，分]
时间 无不良情绪 有不良情绪 1级 2级 3级 4级 术后24 d 90(90，95) 90(89，90) 90(90，98) 90(90，94) 术后7 d 90(90，98) 90(90，90) 95(90，100) 100(93，100) 术后30 d 100(90，100) 98(88，100) 95(95，100) 93(90，99)
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