不同救治模式对急性心肌梗死治疗成本和效益的影响  

Influence of different treatment patterns on cost-effectiveness in treatment of acute myocardial infarction

作　　者：曾红科[1] 方明[2] 叶珩[2] 赖欣[3] 陈纯波[2] 何楷然[2] 詹伟峰[2] 黄国华[2] 林晓军[2] 陆大祥[1] 

机构地区：[1]暨南大学医学院病理生理教研室,广州510632 [2]广东省人民医院急危重症医学部 [3]广州市急救医疗指挥中心

出　　处：《中华医学杂志》2008年第20期1398-1401,共4页National Medical Journal of China

基　　金：广东省科技计划基金资助项目（2003c30606）志谢 广州市急救医疗指挥中心大力支持

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χ^2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18943元±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（33965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。Objective 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 up 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 body 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）. Concclusion The 120-grade 3 A hospital CCU pattern is more cost-effective in treatment of AMI.

关 键 词：医师医疗模式 心肌梗死 急性 成本-效益 

分 类 号：R686[医药卫生—骨科学]