目的 分析缺血性脑卒中(ischemic stroke,IS)患者的住院总费用和住院自付费用及住院总费用构成，并探索影响其住院总费用和住院自付费用的主要因素，为减轻IS患者的经济负担提供依据。方法 收集2019—2024年广东省珠海市两家三级甲等医院的9 944例IS患者的住院数据，统计患者的住院总费用和住院自付费用，分析其住院总费用构成。基于安德森模型，从个人倾向因素、个人能促因素、个人需要因素3个方面探索影响住院总费用和住院自付费用的因素，对费用值进行自然对数转换后采用普通最小二乘法回归分析住院总费用和住院自付费用的影响因素。结果 IS患者次均住院总费用为22 513.11元，中位数是12 690.32元。其中，治疗费占比最高，为47.83%。次均住院自付费用为13 123.04元，中位数是7 189.59元，住院自付费用占比为58.29%。回归结果表明，年龄、性别、医保类型、慢性病患病情况、是否接受手术、住院天数是IS患者住院总费用的影响因素，性别、医保类型、慢性病患病情况、是否接受手术、住院天数是IS患者住院自付费用的影响因素;均P<0.05。结论 IS患者住院总费用和住院自付费用较高，需要因素(慢性病患病情况、是否接受手术、住院天数)是主要影响因素。建议进一步建设基于社区的脑卒中康复中心，建立长期护理保险制度，减少IS患者的经济负担。

Objective To analyze the total inpatient costs,out-of-pocket spending,and cost composition of total inpatient costs for patients with ischemic stroke(IS),and to explore the main factors influencing total inpatient costs and out-ofpocket spending,so as to provide a basis for alleviating the economic burden on IS patients. Methods Inpatient data from9 944 IS patients treated at two tertiary Grade A hospitals in Zhuhai,Guangdong Province,from 2019 to 2024 were collected. Descriptive statistics were conducted to analyze total inpatient costs,out-of-pocket spending, and the composition of total inpatient costs. Based on the Andersen model,factors influencing total inpatient costs and out-ofpocket spending were explored from three dimensions: predisposing factors,enabling factors,and need factors. After natural logarithm transformation,ordinary least squares regression was employed to identify the influencing factors. Results The average total inpatient cost per visit for IS patients was CNY 22 513. 11,with a median of CNY 12 690. 32. Treatment costs accounted for the highest proportion at 47. 83%. The average out-of-pocket spending per visit was CNY 13 123. 04,with a median of CNY 7 189. 59,accounting for 58. 29% of total inpatient costs. Regression analysis indicated that age,gender,type of medical insurance,chronic disease status,receipt of surgery,and length of stay were significant factors affecting total inpatient costs; gender,type of medical insurance,chronic disease status,receipt of surgery,and length of stay were significant factors influencing out-of-pocket spending(all P< 0. 05). Conclusions Both total inpatient costs and out-of-pocket spending for IS patients are high. Need factors such as chronic disease status,receipt of surgery,and length of stay are the main influencing factors. It is recommended to further develop community-based stroke rehabilitation centers and establish long-term care insurance systems to reduce the financial burden on IS patients.