救治模式对不同程度急性心肌梗死治疗成本和效益的影响  

Variance of cost-effectiveness when treat different acute myocardial infarction with different pattern.

作　　者：方明[1] 叶珩[1] 曾红科[1] 赖欣 陈纯波[1] 何楷然[1] 詹伟峰[1] 林晓军[1] 

机构地区：[1]广东省人民医院急危重症医学部,广州510080 [2]广州市120指挥中心

出　　处：《中华急诊医学杂志》2007年第12期1260-1263,共4页Chinese Journal of Emergency Medicine

基　　金：广东省科学技术研究基金(2003c30606)

摘　　要：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不同程度急性心肌梗死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月期间分流到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梗患者,分别按照梗死部位及严重并发症发生情况进一步分为单纯心梗组和复杂心梗组。在出院后半年进行随访,记录其住院总费用、住院期间死亡率,用SF-36量表量化其短期健康状况。以单因素方差分析及卡方检验比较两组间住院费用、死亡率、生活质量的差别。结果相对120-二甲医院模式,120-三甲医院CCU模式下单纯心梗组住院费用较高(P=0.016),住院死亡率无差别,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);复杂心梗组住院费用较高(P= 0.011),住院死亡率较低(P<0.01),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)。结论120-三甲医院CCU模式能为梗死面积大、伴有严重并发症的复杂AMI患者提供更好的治疗效率。分流救治模式的选择对该类患者生存和短期预后的作用不容忽视。Objective To investigate the variance of cost-effectiveness when treat acute myocardial infarction of different severe extents with different pattern. Methods Acute myocardial infarction patients were selected from emergency command center of Guangzhou from October 2003 to December 2005. These patients were assigned by the center to First-Class Hospitals at Grade 3 and First-class Hospital at Grade 2, and were followed up after 6 months after post-discharge. Cost in hospital and mortality in hospital were registered. The health of all patients were quantificated using SF-36. According to the assigned hospitals, the patients were divided into single infarction group and complex infarction group. Cost in hospital, mortality in hospital, short-teIm quality of life were compared between the them. Results Compared with and First-Class Hospital at Grade 2 （ 101 cases）, the single infarction patients in First-Class Hospitals at Grade 3 had higher costs in hospital （ P = 0.016）, better society function, affection role, mental health and health status （P 〈 0.05）, but no difference in mortality in hospital; the complex infarction patients in First-Class Hospitals at Grade 3 had higher costs in hospital （ P = 0.011）, and led better quality of life （such as physical function, general health status, vitality, society function, affection role, mental health and health status, P 〈 0.05）, and lower mortality in hospital （ P 〈 0.01 ）. Conclusions Acute myocardial infarction patients with wider areas and severe complications can obtain better cost-effect when they were assigned to the First-Class Hospitals at Grade 3, and the selection of treatment pattern in such myocardial infarction patients is important to improve their survival rate and short-term quality of life.

关 键 词：模式 急性心肌梗死 部位 并发症 成本-效益 

分 类 号：R542.22[医药卫生—心血管疾病]