CAJ | 학술논문

目的了解颅内压(ICP)监测在重型颅脑创伤(TBI)患者中的应用情况及其对预后和经济负担的影响.方法抽取上海市5家二级以上综合性医院在2009年1月至2011年1月间收治的重型TBI住院患者535例,按是否行ICP监测分为两组(ICP组和非ICP组),对比两组患者的病死率,急性期总住院费用,住院天数,寿命年费用及质量调整寿命年费用.结果重型TBI患者行ICP监测的比例为28.0％.ICP组患者的住院病死率为16.7％,显著低于非ICP组患者的住院病死率32.2％(P＜0.001).多元Logistic回归分析显示行ICP监测的患者死亡风险仅为非ICP监测患者的0.32倍(95％ CI,0.19,0.54).重型颅脑创伤患者行ICP监测可使病死率下降15.5％,但平均多耗费住院费用69 620元(P＜0.001)；行ICP监测的寿命年费用中位数为5 995元,显著高于未行ICP监测的寿命年费用中位数2 236元(P＜0.001)；行ICP监测的质量调整寿命年费用中位数为11 558元,显著高于未行ICP监测的寿命年费用中位数3 938元(P＜0.001).结论我国重型TBI行ICP监测的比例仍较低,重型TBI患者行ICP监测可能会增加经济负担,但却大大降低患者病死率.
목적 료해로내압(ICP)감측재중형로뇌창상(TBI)환자중적응용정황급기대예후화경제부담적영향.방법 추취상해시5가이급이상종합성의원재2009년1월지2011년1월간수치적중형TBI주원환자535례,안시부행ICP감측분위량조(ICP조화비ICP조),대비량조환자적병사솔,급성기총주원비용,주원천수,수명년비용급질량조정수명년비용.결과 중형TBI환자행ICP감측적비례위28.0％.ICP조환자적주원병사솔위16.7％,현저저우비ICP조환자적주원병사솔32.2％(P＜0.001).다원Logistic회귀분석현시행ICP감측적환자사망풍험부위비ICP감측환자적0.32배(95％ CI,0.19,0.54).중형로뇌창상환자행ICP감측가사병사솔하강15.5％,단평균다모비주원비용69 620원(P＜0.001)；행ICP감측적수명년비용중위수위5 995원,현저고우미행ICP감측적수명년비용중위수2 236원(P＜0.001)；행ICP감측적질량조정수명년비용중위수위11 558원,현저고우미행ICP감측적수명년비용중위수3 938원(P＜0.001).결론 아국중형TBI행ICP감측적비례잉교저,중형TBI환자행ICP감측가능회증가경제부담,단각대대강저환자병사솔.
Objective To understand the use of intracranial pressure (ICP)monitoring and to analyze its impact on the prognosis and economic burdens in severe traumatic brain injury (TBI) patients.Methods A multicenter study of five hospitals in Shanghai was performed.535 severe TBI patients between January 2009 and January 2011 and related clinical variables were gathered from the five hospitals.The in-hospital mortality,total hospital costs,length of stay,the cost per life year,and the cost per quality -adjusted life year(QALY) between the ICP group and the non-ICP group were compared.Results The ratio of ICP monitoring in patients with severe traumatic brain injury was 28.0％.The in-hospital mortality in the ICP group was 16.7％,which was significantly lower than the in-hospital mortality in the non-ICP group(32.2％)(P ＜0.001).Multivariate logistic regression analysis showed that the risk of death in the ICP group was only 0.32 times (95％ CI,0.19,0.54) than the non-ICP group.The mortality could decrease 15.5％ with ICP monitoring,but anaverage of 69,620 RMB was increased in hospital costs.The median cost per life year was 5,995 RMB in the ICP group,which was significantly higher than the non-ICP group (2,236 RMB) (P ＜0.001).The median cost per QALY was 11,558 RMB in the ICP group,which was significantly higher than the non-ICP group (3,938 RMB) (P ＜ 0.001).Conclusion The proportion of ICP monitoring in severe traumatic brain injury was still low.ICP monitoring in severe traumatic brain injury patients could reduce mortality but increase the economic burdens of patients.