医院管理案例剖析-DRGs的绩效评价与推广.pptx

1、医院管理案例剖析-DRGs的绩效评价与推广 DRGs的推广与应用 DRGs面临的挑战与思考 参考材料与资讯平台提 纲DRGs系统的发展“诊断相关组（Diagnosis-related Groups，DRGs）”诞生于上世界60年代末的美国。1920s DRG系统出现，凸现在管理上的优势DRG国际化发展，自美国扩展至世界各国BJ-DRGs诞生1960s1980s1990s选医生的难题，病例组合思想出现1920s在中国的相关 研究，从争论到开发到初步应用2008yCN-DRGs分组方案诞生2015y病例组合思想病例组合思想：临床过程复杂相似与医疗资源消耗相似 WeightWeight：DRG权重与

2、医院总权重 在计量权重时，考虑到目前国内医疗费用的构成扭曲，我们以38类医疗费用为基础，将患者住院总费用分为“医疗”、“护理”、“医技”、“药品”和“管理”五大类，每个大类各赋予相同的权重（20%）进行标化调整，然后计量各个DRG组的全市权重Wi。如果分别用n1、n2、nk分别表示这个医院各个DRGs覆盖的病例数，那么，这个医院风险调整思想风险调整思想：基于权重思想进行实现组间比较全体病例的例均费用组内病例的例均费用该的权重某DRGDRG世界上超过30个国家和地区使用DRGs分组系统MATURINGGROWTHEMBRYONICPRE-EMBRYONICCanadaUnited StatesM

3、exicoUruguayArgentinaAustraliaNew ZealandTaiwanHong KongUAEGermanySwitzerlandItalySpainPortugalFranceBelgiumUKPuerto RicoCzech RepublicSingaporeChinaJapanMalaysiaBrazilChileIndonesiaCosta RicaSaudiQatarPeruNetherlandsColumbiaCN-DRGs分组方案介绍分组方案介绍基本术语基本术语 MDCMDC：Major Diagnostic CategoryMajor Diagnosti

4、c Category，主要疾，主要疾病分类病分类 A-DRGA-DRG：Adjacent-DRGAdjacent-DRG，简称，简称A-DRGA-DRG，基干，基干DRGDRG DRGDRG：由由A-DRGA-DRG根据根据病例个体特病例个体特征征 、年龄、合并症及并发症、年龄、合并症及并发症 分入相应分入相应DRGDRG组别中组别中 DRGDRG分组分组过程图图CN-DRGs分组过程外科部分非外科、非内科部分内科部分手术室手术、操作（ICD-9-CM3）手术分级、诊断诊断或治疗性操作（非手术室手术）（ICD-9-CM3）主要诊断或症状、肿瘤及其他情况年龄、并发症及合并症DRGs(P)DRGs

5、(O)DRGs(M)26个诊断类目及类目以外的DRGs (MDC)主要诊断（ICD-10CM）CN-DRGCN-DRG分组名称的构成分组名称的构成NB19NB19、NC13NC13 第一位码：是疾病的诊断分类（Major Diagnostic Category，简称MDC）代码，用AZ 26个字母表示，根据病案首页的主要诊断，进入相应的疾病诊断分类。MDC目录MDC编码MDC名称MDCAMDCA先期分组疾病及相关操作MDCB神经系统疾病及功能障碍MDCC眼科疾病及功能障碍MDCD头颈、耳、鼻、喉、口腔疾病及功能障碍MDCE呼吸系统疾病及功能障碍MDCF循环系统疾病及功能障碍MDCG消化系统疾病

6、及障碍MDCH肝、胆、胰疾病及功能障碍MDCI肌肉、骨骼疾病及功能障碍MDCJ皮肤、皮下组织及乳腺疾病及功能障碍MDCK内分泌、营养代谢疾病及功能障碍MDCL肾脏及泌尿疾病及功能障碍MDCM男性生殖系统疾病及功能障碍MDCN女性生殖系统疾病及功能障碍MDCO妊娠、分娩及产褥期MDCPMDCP新生儿及其他围产新生儿疾病MDCQ血液、造血器官及免疫疾病和功能障碍MDCR骨髓增生疾病和功能障碍MDCS感染及寄生虫（全身或不明确部位的）MDCT精神疾病及功能障碍MDCU酒精/药物使用及其引起的器质性精神功能障碍MDCV创伤、中毒及药物毒性反应MDCW烧伤MDCX影响健康因素及其他就医情况MDCYMDC

7、YHIY感染疾病及相关操作MDCZMDCZ多发严重创伤CN-DRGCN-DRG分组名称的构成分组名称的构成 第二位码：第二位码：DRG类型，根据处理方式不同分为内科部分、外科部分、非内非外部分（接受特殊检查，如导管、内镜检查等），用字母表示。外科部分：A，B，C，D，E，F，G，H，J 9个字母表示。内科部分：R，S，T，U，V，W，X，Y，Z 9个字母表示。非内非外部分：K，L，M，N，P，Q 6个字母表示。第三位码：阿拉伯数字（1-9），为DRG组的顺序码CN-DRGCN-DRG分组名称的构成分组名称的构成 第四位码：第四位码：阿拉伯数字，表示是否有合并症和伴随病以及其他相关信息。尾数为0

8、：年龄17岁，未作区分；尾数为9：未作区分；尾数为1：伴重要合并症与伴随病；尾数为2：伴重要合并症与伴随病，年龄17岁；尾数为3：伴合并症与伴随病；尾数为4：伴合并症与伴随病，年龄17岁；尾数为5：不伴合并症与伴随病；尾数为6：不伴合并症与伴随病，年龄17岁；尾数为7：住院5天之内死亡或者转院；CN-DRG分组名称的构成E S 1 1 呼吸系统感染/炎症，伴严重要合并症与和并发病表示伴有严重要合并症与和并发病表示该组DRG的排列顺序表示该组属于内科部分表示该组属于呼吸系统的MDC病例病例大类ADRGsDRGs医生统计DA1头颈恶性肿瘤大手术DC1 中耳/内耳手术DE2 扁桃体和/或腺体样切除手

9、术DR1头颈、耳、鼻、咽、口恶性肿瘤DT1中耳炎及上呼吸道感染中耳/内耳手术，0-17岁（权重0.95）中耳/内耳手术,18岁以上（权重0.92）头颈、耳、鼻、咽、口恶性肿瘤,不伴C.C.（权重1.27）头颈、耳、鼻、咽、口恶性肿瘤,伴一般C.C.（权重1.68）头颈、耳、鼻、咽、口恶性肿瘤,伴严重C.C.（权重1.91）B.神经系统C.眼部D.耳鼻喉咽E.呼吸系统O.妊娠和生育P.新生儿Q.血液和免疫Y.HIV感染Z.多发性创伤A.先期分组DRGs分组路径治疗方式治疗方式DRG组组权重权重手术治疗手术治疗FC23-冠状动脉搭桥，伴心导管操作，伴合并症冠状动脉搭桥，伴心导管操作，伴合并症与并发

10、症与并发症5.55FC25-冠状动脉搭桥，伴心导管操作，不伴合并症冠状动脉搭桥，伴心导管操作，不伴合并症与并发症与并发症4.65FC31-冠状动脉搭桥，伴重要合并症冠状动脉搭桥，伴重要合并症与并发症与并发症5.29FC35-冠状动脉搭桥，不伴合并症冠状动脉搭桥，不伴合并症与并发症与并发症4.37介入治疗介入治疗FM11-经皮心血管操作及冠状动脉药物洗脱支架植入，伴经皮心血管操作及冠状动脉药物洗脱支架植入，伴AMI/HF/SHOCK2.4内科治疗内科治疗FR11-急性心肌梗死，伴重要合并症急性心肌梗死，伴重要合并症与并发症与并发症2.22FR13-急性心肌梗死，伴合并症急性心肌梗死，伴合并症与并

11、发症与并发症1.4FR15-急性心肌梗死，不伴合并症急性心肌梗死，不伴合并症与并发症与并发症0.88住院住院5天内天内死亡死亡FR17-急性心肌梗死，不伴合并症急性心肌梗死，不伴合并症与并发症，与并发症，住院少于住院少于5天或死天或死亡或转院亡或转院0.54心梗患者DRG分组举例疾病诊断(ICD-10)疾病治疗(ICD-9)个体特征(CC-MCC)单病种DRGs病例组合思想分类与简化便于管理病例组合思想病例组合思想分类与简化便于管理分类与简化便于管理 什么是DRGs DRGs面临的挑战与思考 参考材料与资讯平台提 纲20042004年，北年，北京市京市二次二次启启动动D DRGRG研究研究工作

12、工作。2004年2008年20082008年，成功开年，成功开发基于北京地区发基于北京地区特点的特点的DRGDRG版本，版本，命名为命名为“北京版北京版诊断相关组诊断相关组（BJ-DRGBJ-DRG）”。BJ-DRGBJ-DRG连年连年应用于全市应用于全市医院医疗服医院医疗服务评价。目务评价。目前已升级至前已升级至20142014版。版。20112011年，北京启年，北京启动动DRGs-PPSDRGs-PPS试点试点工作。工作。2011年20132013年，北京市公年，北京市公共卫生信息中心组共卫生信息中心组织临床专家进行分织临床专家进行分组方案论证。组方案论证。20042004年，成立年，成

13、立卫生信息中心卫生信息中心，迄今已建立，迄今已建立起包含超过起包含超过20002000万份出院万份出院病案首页信息病案首页信息的数据库。的数据库。2013年DRGs推广历程20132013年以来，年以来，国家卫生计国家卫生计生委委托北生委委托北京牵头全国京牵头全国1818省市推广省市推广北京北京DRGsDRGs管管理办法。理办法。2013年2014年20142014年，北京市年，北京市公共卫生信息中公共卫生信息中心基于心基于DRGsDRGs分组分组器开发省级住院器开发省级住院服务绩效评价平服务绩效评价平台。台。20152015年，北京市年，北京市启动怀柔区新农启动怀柔区新农合综合支付制度合综合

14、支付制度（DRGsDRGs）改革试）改革试点工作。点工作。2015年20152015年，国家指定年，国家指定北京市公共卫生信北京市公共卫生信息中心作为国家息中心作为国家DRGDRG质控中心，开质控中心，开展全国展全国DRGDRG研究推研究推广工作。广工作。20132013年，北京市年，北京市启动平谷区新农启动平谷区新农合综合支付制度合综合支付制度（DRGsDRGs）改革试）改革试点工作。点工作。DRGs推广历程目前，与我中心联系启动DRGs相关工作（部分已搭建了省级平台）的省份已有18个，其中有广东、内蒙古、湖北、重庆等10个省应用了省级绩效评价平台，全面开展了DRGs应用工作。2016年除北

15、京地区以外的医疗机构相继开展医院层面的DRGs评价管理工作，如，广东省人民医院、空军总医院、湘雅三院、301医院、浙大一附院、新疆一附院等。DRGs推广历程 DRGs在医疗卫生管理中的应用 1.配合北京卫生管理部门完成北京地区医疗机构住院服务绩效评价工作；2.配合国家卫生管理部门完成全国住院医疗服务绩效评价工作；3.配合卫生管理部门完成临床专科评价工作；4.支持、指导医疗机构完成医院内部评价管理等工作。DRGs应用27家专科医院（按类别分别评价）73家综合医院（进一步按急症特征筛选出58家）39家中医医院未报送数据的机构29家年内出院人数小于100的机构19家234家二级以上医疗 机构 参评机

16、构100100家家（含3家一级机构）停业及未开业机构10家2015全市二级及以上医疗机构住院医疗服务绩效评价 未参评机构129129家家7类情况精神、口腔、整形、老年类医院19家首页信息上报率低于80%的医院9家10家病案首页不合格医院（与以上6类有重合）案例分享（北京）评价指标维度指标评价内容能力DRG组数 病例组合指数(标化CMI)值学科发展均衡性治疗病例所覆盖疾病类型的范围 各学科治疗病例的平均技术难度水平专业缺失及专业能力指数情况效率费用消耗指数 治疗同类疾病所花费的费用 时间消耗指数 治疗同类疾病所花费的时间 安全低风险组死亡率 疾病本身导致死亡概率极低的病例死亡率 1 1、医疗服务

17、能力、医疗服务能力 1.3 1.3 CMI（Case-Mix Index）：病例组合指数 国际上将CMI值作为评判医疗服务技术难度的重要指标，其基本思想是：如果所有医疗机构治疗此类病例所耗费的医疗资源都较高，说明治疗此类疾病的难度较大。该医院全体病例数的病例数该医院该费用权重某病例组合指数DRGDRGCMIDRGs相关绩效评价指标介绍DRGs相关绩效评价指标介绍2 2、医疗、医疗服务效率服务效率 通过费用消耗指数及时间消耗指数费用消耗指数及时间消耗指数两个指标，即治疗同类疾病医疗费用高低和住院时间长短来反映。计算方法为：2 2、医疗服务效率、医疗服务效率 费用消耗指数及时间消耗指数：指数值等于

18、1时为平均状态。指数值小于1，表示医疗费用较低或住院时间较短，说明该医院的服务效率较高；指数值大于1，表示医疗费用较高或住院时间较长，说明该医院的服务效率较低。DRGs相关绩效评价指标介绍3、医疗安全 医疗安全指标采用了低风险和中低风低风险和中低风险组病例死亡率险组病例死亡率，利用各DRGs病例的住院死亡率对不同DRG进行死亡风险分级。具体计算方法如下：DRGs相关绩效评价指标介绍ln_mor,1,-2.58362262ln_mor,257,-1.01197598ln_mor,2,-4.22673375ln_mor,258,-2.3580978ln_mor,3,-5.11599581ln_mo

19、r,259,-5.54677873ln_mor,4,-4.52820914ln_mor,260,-5.47267075ln_mor,5,-1.26230838ln_mor,261,-7.82404601ln_mor,6,-2.0310324ln_mor,262,-8.11172808ln_mor,7,-3.07477548ln_mor,263,-5.68397985ln_mor,8,-4.20639407ln_mor,264,-7.01311579ln_mor,9,-3.14888345ln_mor,265,-3.44201938ln_mor,10,-3.21887582ln_mor,266,

20、-4.14774534ln_mor,11,-4.29768549ln_mor,267,-6.90775528ln_mor,12,-5.47267075ln_mor,268,-5.44914026ln_mor,13,-4.93367425ln_mor,269,-6.07484616ln_mor,14,-4.27586644ln_mor,270,-6.31996861ln_mor,15,-6.8124451ln_mor,271,-2.88957208ln_mor,16,-3.71727893ln_mor,272,-1.50282818ln_mor,17,-5.1672891ln_mor,273,-

21、3.58993951ln_mor,18,-4.91988093ln_mor,274,-7.4185809ln_mor,19,-2.12443891ln_mor,275,-7.26443022ln_mor,20,-3.06830297ln_mor,276,-9.21034037ln_mor,21,-2.7985221ln_mor,277,-8.51719319ln_mor,22,-4.44816644ln_mor,278,-4.58536756ln_mor,23,-4.47414192ln_mor,279,-5.06720565ln_mor,24,-6.57128304ln_mor,280,-1

22、.27905561ln_mor,25,-6.64539101ln_mor,281,-3.92713664ln_mor,26,-7.60090246ln_mor,282,-6.90775528ln_mor,27,-3.25969782ln_mor,283,-8.11172808ln_mor,28,-3.78980537ln_mor,284,-9.21034037ln_mor,29,-4.42284863ln_mor,285,-8.51719319ln_mor,30,-5.99146455ln_mor,286,-9.21034037ln_mor,31,-4.01184334ln_mor,287,-

23、5.42615074ln_mor,32,-4.29768549ln_mor,288,-9.21034037ln_mor,33,-1.59948758ln_mor,289,-8.51719319ln_mor,34,-6.2146081ln_mor,290,-9.21034037ln_mor,35,-7.13089883ln_mor,291,-4.11659017ln_mor,36,-2.92248181ln_mor,292,-3.17725415ln_mor,37,-4.74443225ln_mor,293,-4.48295255ln_mor,38,-6.2146081ln_mor,294,-2

24、.29461692ln_mor,39,-7.4185809ln_mor,295,-4.12893601ln_mor,40,-3.47376807ln_mor,296,-6.07484616ln_mor,41,-5.40367788ln_mor,297,-7.4185809ln_mor,42,-6.50229017ln_mor,298,-8.11172808ln_mor,43,-9.21034037ln_mor,299,-8.11172808ln_mor,44,-3.89222038ln_mor,300,-3.94765018ln_mor,45,-1.51321905ln_mor,301,-5.

25、68397985ln_mor,46,-2.90224193ln_mor,302,-3.68488743ln_mor,47,-8.11172808ln_mor,303,-5.20300719ln_mor,48,-8.51719319ln_mor,304,-3.07045582ln_mor,49,-8.11172808ln_mor,305,-4.56594947ln_mor,50,-7.26443022ln_mor,306,-6.50229017ln_mor,51,-3.64199587ln_mor,307,-4.76768912ln_mor,52,-6.57128304ln_mor,308,-8

26、.51719319ln_mor,53,-3.03863977ln_mor,309,-5.91450351ln_mor,54,-5.31852007ln_mor,310,-5.47267075ln_mor,55,-5.95224383ln_mor,311,-5.44914026ln_mor,56,-4.57561138ln_mor,312,-5.40367788ln_mor,57,-1.02834024ln_mor,313,-4.85363155ln_mor,58,-2.34549259ln_mor,314,-4.00085422ln_mor,59,-2.85249811ln_mor,315,-

27、3.60453831ln_mor,60,-1.43927329ln_mor,316,-3.5684333ln_mor,61,-2.49738417ln_mor,317,-3.51660823ln_mor,62,-3.69691163ln_mor,318,-2.96423361ln_mor,63,-6.26590139ln_mor,319,-2.81674962ln_mor,64,-2.92248181ln_mor,320,-2.62831523ln_mor,65,-4.43121688ln_mor,321,-2.15675464ln_mor,66,-5.57275421ln_mor,322,-

28、2.05650657ln_mor,67,-6.16581793ln_mor,323,-1.93933183ln_mor,68,-2.9877641ln_mor,324,-1.94561019ln_mor,69,-5.44914026ln_mor,325,-1.38629436ln_mor,70,-5.20300719ln_mor,326,-7.01311579ln_mor,71,-3.43889925ln_mor,327,-6.8124451ln_mor,72,-3.74650857ln_mor,328,-6.07484616ln_mor,73,-5.14989736ln_mor,329,-5

29、.80914299ln_mor,74,-1.31900961ln_mor,330,-5.68397985ln_mor,75,-1.6638941ln_mor,331,-5.62682143ln_mor,76,-2.29660302ln_mor,332,-5.09946651ln_mor,77,-2.87706074ln_mor,333,-5.05145729ln_mor,78,-4.36615329ln_mor,334,-4.30506559ln_mor,79,-3.61562899ln_mor,335,-4.14143617ln_mor,80,-2.59026717ln_mor,336,-4

30、.07454193ln_mor,81,-5.05145729ln_mor,337,-3.85848224ln_mor,82,-8.11172808ln_mor,338,-3.78980537ln_mor,83,-4.24749574ln_mor,339,-2.63945741ln_mor,84,-2.50103603ln_mor,340,-1.86626752ln_mor,85,-4.55638002ln_mor,341,-4.60517019ln_mor,86,-4.25451331ln_mor,342,-1.46360746ln_mor,87,-4.09234656ln_mor,343,-

31、2.92807363ln_mor,88,-2.86645994ln_mor,344,-3.63818634ln_mor,89,-3.24676103ln_mor,345,-1.60943791ln_mor,90,-4.17990245ln_mor,346,-3.39919938ln_mor,91,-4.74443225ln_mor,347,-1.94561019ln_mor,92,-4.60517019ln_mor,348,-4.4918415ln_mor,93,-4.85363155ln_mor,349,-8.11172808ln_mor,94,-4.45675018ln_mor,350,-

32、6.8124451ln_mor,95,-5.24004846ln_mor,351,-1.29938299ln_mor,96,-6.50229017ln_mor,352,-4.45675018ln_mor,97,-4.29035945ln_mor,353,-1.79155949ln_mor,98,-7.26443022ln_mor,354,-3.22892616ln_mor,99,-6.07484616ln_mor,355,-1.71091708ln_mor,100,-6.90775528ln_mor,356,-5.06720565ln_mor,101,-4.87960703ln_mor,357

33、,-2.55104645ln_mor,102,-3.80766299ln_mor,358,-4.91988093ln_mor,103,-3.5684333ln_mor,359,-4.43121688ln_mor,104,-5.42615074ln_mor,360,-7.13089883ln_mor,105,-3.77226106ln_mor,361,-1.57407077ln_mor,106,-4.55638002ln_mor,362,-3.41124772ln_mor,107,-6.26590139ln_mor,363,-6.37712703ln_mor,108,-3.90207267ln_

34、mor,364,-5.42615074ln_mor,109,-0.33981783ln_mor,365,-6.31996861ln_mor,110,-3.14888345ln_mor,366,-5.59942246ln_mor,111,-3.71727893ln_mor,367,-6.50229017ln_mor,112,-5.29831737ln_mor,368,-2.88598141ln_mor,113,-1.70594881ln_mor,369,-2.95843649ln_mor,114,-3.39322921ln_mor,370,-6.31996861ln_mor,115,-4.595

35、21986ln_mor,371,-4.55638002ln_mor,116,-5.44914026ln_mor,372,-3.53358657ln_mor,117,-5.87813586ln_mor,373,-4.24749574ln_mor,118,-3.97389841ln_mor,374,-4.60517019ln_mor,119,-6.43775165ln_mor,375,-2.24620476ln_mor,120,-6.26590139ln_mor,376,-4.33514305ln_mor,121,-8.51719319ln_mor,377,-3.17725415ln_mor,12

36、2,-2.61455986ln_mor,378,-3.43268805ln_mor,123,-3.50323011ln_mor,379,-3.75930192ln_mor,124,-2.83361342ln_mor,380,-4.90627528ln_mor,125,-3.13960264ln_mor,381,-5.13280293ln_mor,126,-4.22673375ln_mor,382,-5.06720565ln_mor,127,-1.6638941ln_mor,383,-7.60090246ln_mor,128,-2.9077214ln_mor,384,-3.68887945ln_

37、mor,129,-4.35052797ln_mor,385,-0.40541511ln_mor,130,-5.95224383ln_mor,386,-2.19732458ln_mor,131,-4.73300356ln_mor,387,-2.39799528ln_mor,132,-4.77952357ln_mor,388,-2.77579385ln_mor,133,-6.8124451ln_mor,389,-4.50081017ln_mor,134,-4.00633368ln_mor,390,-0.87899495ln_mor,135,-4.81589122ln_mor,391,-0.6931

38、4718ln_mor,136,-3.37845789ln_mor,392,-4.94766049ln_mor,137,-3.79869432ln_mor,393,-2.25094186ln_mor,138,-5.27851474ln_mor,394,-0.46076642ln_mor,139,-3.32980739ln_mor,395,-4.09234656ln_mor,140,-3.93222571ln_mor,141,-6.16581793ln_mor,142,-5.11599581ln_mor,143,-5.08320599ln_mor,144,-4.37405847ln_mor,145

39、,-6.50229017ln_mor,146,-9.21034037ln_mor,147,-6.50229017ln_mor,148,-7.13089883ln_mor,149,-8.11172808ln_mor,150,-6.64539101ln_mor,151,-9.21034037ln_mor,152,-2.89498237ln_mor,153,-3.05124498ln_mor,154,-4.27586644ln_mor,155,-4.81589122ln_mor,156,-4.16048436ln_mor,157,-5.25909665ln_mor,158,-6.31996861ln

40、_mor,159,-1.03761127ln_mor,160,-2.32687779ln_mor,161,-2.59829934ln_mor,162,-4.24052707ln_mor,163,-3.12812146ln_mor,164,-5.38169898ln_mor,165,-3.51660823ln_mor,166,-7.13089883ln_mor,167,-4.94766049ln_mor,168,-6.37712703ln_mor,169,-5.24004846ln_mor,170,-6.43775165ln_mor,171,-6.07484616ln_mor,172,-4.10

41、43949ln_mor,173,-7.26443022ln_mor,174,-3.73387682ln_mor,175,-6.8124451ln_mor,176,-3.78539035ln_mor,177,-4.26158048ln_mor,178,-6.31996861ln_mor,179,-3.36101559ln_mor,180,-5.62682143ln_mor,181,-8.51719319ln_mor,182,-3.46413718ln_mor,183,-4.52820914ln_mor,184,-3.29683737ln_mor,185,-3.08129016ln_mor,186

42、,-5.29831737ln_mor,187,-3.28075123ln_mor,188,-4.97623387ln_mor,189,-6.72543372ln_mor,190,-1.06566119ln_mor,191,-2.4453014ln_mor,192,-4.11047394ln_mor,193,-7.01311579ln_mor,194,-3.35240722ln_mor,195,-6.43775165ln_mor,196,-4.41454983ln_mor,197,-6.43775165ln_mor,198,-6.16581793ln_mor,199,-5.80914299ln_

43、mor,200,-4.65646348ln_mor,201,-8.11172808ln_mor,202,-5.91450351ln_mor,203,-8.51719319ln_mor,204,-5.71383281ln_mor,205,-8.11172808ln_mor,206,-5.29831737ln_mor,207,-6.16581793ln_mor,208,-4.90627528ln_mor,209,-4.47414192ln_mor,210,-3.4514386ln_mor,211,-4.99083267ln_mor,212,-5.68397985ln_mor,213,-6.6453

44、9101ln_mor,214,-8.11172808ln_mor,215,-4.58536756ln_mor,216,-4.44816644ln_mor,217,-6.8124451ln_mor,218,-7.60090246ln_mor,219,-8.51719319ln_mor,220,-6.37712703ln_mor,221,-5.27851474ln_mor,222,-8.11172808ln_mor,223,-2.03945189ln_mor,224,-3.89713439ln_mor,225,-5.95224383ln_mor,226,-5.91450351ln_mor,227,

45、-4.40631933ln_mor,228,-1.3787231ln_mor,229,-3.73387682ln_mor,230,-2.99174025ln_mor,231,-4.84089252ln_mor,232,-4.94766049ln_mor,233,-6.8124451ln_mor,234,-8.51719319ln_mor,235,-5.11599581ln_mor,236,-5.84304454ln_mor,237,-5.24004846ln_mor,238,-6.31996861ln_mor,239,-3.55434856ln_mor,240,-5.71383281ln_mo

46、r,241,-1.80059842ln_mor,242,-3.80766299ln_mor,243,-4.62537289ln_mor,244,-6.31996861ln_mor,245,-4.58536756ln_mor,246,-5.54677873ln_mor,247,-5.99146455ln_mor,248,-5.52146092ln_mor,249,-4.63562939ln_mor,250,-5.59942246ln_mor,251,-5.84304454ln_mor,252,-5.49676831ln_mor,253,-7.60090246ln_mor,254,-2.16630

47、747ln_mor,255,-2.33510828ln_mor,256,-3.60086858系列2,1,-4.7166系列2,257,-4.7166系列2,2,-4.7166系列2,258,-4.7166系列2,3,-4.7166系列2,259,-4.7166系列2,4,-4.7166系列2,260,-4.7166系列2,5,-4.7166系列2,261,-4.7166系列2,6,-4.7166系列2,262,-4.7166系列2,7,-4.7166系列2,263,-4.7166系列2,8,-4.7166系列2,264,-4.7166系列2,9,-4.7166系列2,265,-4.7166系

48、列2,10,-4.7166系列2,266,-4.7166系列2,11,-4.7166系列2,267,-4.7166系列2,12,-4.7166系列2,268,-4.7166系列2,13,-4.7166系列2,269,-4.7166系列2,14,-4.7166系列2,270,-4.7166系列2,15,-4.7166系列2,271,-4.7166系列2,16,-4.7166系列2,272,-4.7166系列2,17,-4.7166系列2,273,-4.7166系列2,18,-4.7166系列2,274,-4.7166系列2,19,-4.7166系列2,275,-4.7166系列2,20,-4.7

49、166系列2,276,-4.7166系列2,21,-4.7166系列2,277,-4.7166系列2,22,-4.7166系列2,278,-4.7166系列2,23,-4.7166系列2,279,-4.7166系列2,24,-4.7166系列2,280,-4.7166系列2,25,-4.7166系列2,281,-4.7166系列2,26,-4.7166系列2,282,-4.7166系列2,27,-4.7166系列2,283,-4.7166系列2,28,-4.7166系列2,284,-4.7166系列2,29,-4.7166系列2,285,-4.7166系列2,30,-4.7166系列2,286

50、,-4.7166系列2,31,-4.7166系列2,287,-4.7166系列2,32,-4.7166系列2,288,-4.7166系列2,33,-4.7166系列2,289,-4.7166系列2,34,-4.7166系列2,290,-4.7166系列2,35,-4.7166系列2,291,-4.7166系列2,36,-4.7166系列2,292,-4.7166系列2,37,-4.7166系列2,293,-4.7166系列2,38,-4.7166系列2,294,-4.7166系列2,39,-4.7166系列2,295,-4.7166系列2,40,-4.7166系列2,296,-4.7166系列