中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2008年
20期
1398-1401
,共4页
曾红科%方明%叶珩%赖欣%陈纯波%何楷然%詹伟峰%黄国华%林晓军%陆大祥
曾紅科%方明%葉珩%賴訢%陳純波%何楷然%詹偉峰%黃國華%林曉軍%陸大祥
증홍과%방명%협형%뢰흔%진순파%하해연%첨위봉%황국화%림효군%륙대상
医师医疗模式%心肌梗死%急性%成本-效益
醫師醫療模式%心肌梗死%急性%成本-效益
의사의료모식%심기경사%급성%성본-효익
Physician's practice pattern%Myocardical infarction%Acute%Cost-effectiveness
目的 探讨120-三甲医院CCU和120-二甲医院两种分流救治模式对急性心肌梗死(AMI)患者治疗成本和效益的影响.方法 由广州市120急救指挥中心提供资料,纳入2003年10月至2005年12月期间分流广州市三甲医院进入CCU和分流到广州市二甲医院的急性心肌梗死患者,并在出院后半年内进行随访,记录其住院总费用、住院期间主要干预手段、死亡、再梗死、卒中等预后情况和冠心病二级预防情况,用SF-36量表量化其健康状况.以单因素方差分析及X2检验比较两组间住院费用、生活质量、短期预后和冠心病二级预防的差别.结果 相对120-二甲医院模式组(成功随访101例,住院费用为18 943元4-893元,病死率18/101,卒中率12/101),120-三甲医院CCU模式组(成功随访137例)的住院费用(33 965元±963元)较高(P=0.012),出院后病死率(11/137)、卒中发生率(5/137)均较低(P=0.022,0.015),再次心肌梗死发生率两组差异无统计学意义.120-三甲医院CCU模式组的躯体功能、一般健康状况、生命力、社会功能、情感角色、心理健康、总体健康状况得分方面较高(P＜0.05).躯体角色、肌体疼痛得分两组差异无统计学意义.120-三甲医院CCU模式组的出院后的专科门诊随访次数、戒烟率、他汀类药物使用率较高,P值分别为0.017,0.016,0.038.血管紧张素转化酶抑制剂及β受体阻滞剂使用率两组差异无统计学意义.结论 120-三甲医院CCU模式能为AMI患者提供更好的治疗效率,值得120急救指挥中心借鉴.
目的 探討120-三甲醫院CCU和120-二甲醫院兩種分流救治模式對急性心肌梗死(AMI)患者治療成本和效益的影響.方法 由廣州市120急救指揮中心提供資料,納入2003年10月至2005年12月期間分流廣州市三甲醫院進入CCU和分流到廣州市二甲醫院的急性心肌梗死患者,併在齣院後半年內進行隨訪,記錄其住院總費用、住院期間主要榦預手段、死亡、再梗死、卒中等預後情況和冠心病二級預防情況,用SF-36量錶量化其健康狀況.以單因素方差分析及X2檢驗比較兩組間住院費用、生活質量、短期預後和冠心病二級預防的差彆.結果 相對120-二甲醫院模式組(成功隨訪101例,住院費用為18 943元4-893元,病死率18/101,卒中率12/101),120-三甲醫院CCU模式組(成功隨訪137例)的住院費用(33 965元±963元)較高(P=0.012),齣院後病死率(11/137)、卒中髮生率(5/137)均較低(P=0.022,0.015),再次心肌梗死髮生率兩組差異無統計學意義.120-三甲醫院CCU模式組的軀體功能、一般健康狀況、生命力、社會功能、情感角色、心理健康、總體健康狀況得分方麵較高(P＜0.05).軀體角色、肌體疼痛得分兩組差異無統計學意義.120-三甲醫院CCU模式組的齣院後的專科門診隨訪次數、戒煙率、他汀類藥物使用率較高,P值分彆為0.017,0.016,0.038.血管緊張素轉化酶抑製劑及β受體阻滯劑使用率兩組差異無統計學意義.結論 120-三甲醫院CCU模式能為AMI患者提供更好的治療效率,值得120急救指揮中心藉鑒.
목적 탐토120-삼갑의원CCU화120-이갑의원량충분류구치모식대급성심기경사(AMI)환자치료성본화효익적영향.방법 유엄주시120급구지휘중심제공자료,납입2003년10월지2005년12월기간분류엄주시삼갑의원진입CCU화분류도엄주시이갑의원적급성심기경사환자,병재출원후반년내진행수방,기록기주원총비용、주원기간주요간예수단、사망、재경사、졸중등예후정황화관심병이급예방정황,용SF-36량표양화기건강상황.이단인소방차분석급X2검험비교량조간주원비용、생활질량、단기예후화관심병이급예방적차별.결과 상대120-이갑의원모식조(성공수방101례,주원비용위18 943원4-893원,병사솔18/101,졸중솔12/101),120-삼갑의원CCU모식조(성공수방137례)적주원비용(33 965원±963원)교고(P=0.012),출원후병사솔(11/137)、졸중발생솔(5/137)균교저(P=0.022,0.015),재차심기경사발생솔량조차이무통계학의의.120-삼갑의원CCU모식조적구체공능、일반건강상황、생명력、사회공능、정감각색、심리건강、총체건강상황득분방면교고(P＜0.05).구체각색、기체동통득분량조차이무통계학의의.120-삼갑의원CCU모식조적출원후적전과문진수방차수、계연솔、타정류약물사용솔교고,P치분별위0.017,0.016,0.038.혈관긴장소전화매억제제급β수체조체제사용솔량조차이무통계학의의.결론 120-삼갑의원CCU모식능위AMI환자제공경호적치료효솔,치득120급구지휘중심차감.
objeetive To investigate the influences of different treatment patterns on the costeffectiveness in treating acute myocardial infarction(AMI).Methods Data about referral of AMI patients who called for help because of chest pain to the nearby hospitals from October 2003 to December 2005 were collected from the Guangzhou 120 Call Center.All these patients were followed uD 6 months after discharge to survey the cost during hospitalization,major treatment,prognosis(death,re-infarction,stroke etc.),and secondary prevention for coronary heart disease.We used SF-36 scale was used to quantify the health status.Results 101 AMI patients referred to grade 2 A hospitals(Group A)and 137 patients referred to grade 3 A hospitals(Group B)were successfully followed up.The cost during hospitalization of Group B was (33 965±963)yuan RMB,significantly higher than that of Group A(18 943±893)yuan,P=0.021).11 patients of Group B died,and 5 patients suffered from stroke with the mortality and stroke rate both significantly lower than those of Group A(18/101 and 12/101,P=0.022,P=0.015).There was no significant difference in the re-infarction rate between the 2 groups.The scores in physical function.general health status,vitality,social function,role-emotional,mental health of Group B were all significantly higher than those of Group A(all P＜0.05),however,there were not significant differences in bodv pain and role-physical between these 2 groups.The smoking cessation rate,specialist outpatient department follow-up rate,statins use rate of Group B were significantly higher than those of Group A(P=0.017,P=0.016,P=0.038).Conclusion The 120-grade 3 A hospital CCU pattern is more cost-effective in treatment of AMI.
