心脏起搏器植入术687例治疗效果及费用的评价与分析  

Medical-Economic Evaluation of Cardiac Pacemaker in 687 Cases

作　　者：李淑敏[1] 郭涛[1] 周栋[1] 刘中梅[1] 孙勇[1] 

机构地区：[1]昆明医学院第一附属医院心内科,云南昆明650032

出　　处：《昆明医学院学报》2010年第9期91-97,119,共8页Journal of Kunming Medical College

摘　　要：目的研究我国目前心脏起搏治疗费用,从卫生经济学角度对心脏起搏治疗进行评价,以合理利用我国卫生资源,提高患者长期生存质量.方法采用逐步纳入研究的方法连续收集2003年1月至2007年12月在昆明医学院第一附属医院行永久心脏起搏器植入术687例患者资料,记录基本情况、基础疾病、心功能分级、生活质量评分、起搏器种类、费用支出、医疗付款方式等相关资料,随访手术前后6个月生活质量评分改变、后续费用、并发症及其对治疗成本的影响.结果手术成功687例(成功率100%),并发症9例(发生率1.3%),无死亡.初次植入心脏起搏器564例,患者心功能、生活质量均显著改善,再次住院率下降.起搏器费用为直接费用主体,直接费用中DDD组高于VVI/AAI组,ICD/CRT组明显高于DDD组,CRT-D组明显高于ICD/CRT组,差异有统计学意义.城镇职工基本医疗保险和自费为医疗付款方式主体,687例中城镇职工基本医疗保险390例,自费257例,公费40例.平均心脏起搏器使用年限AAI/VVI长于DDD,DDD长于ICD/CRT,有显著统计学差异.结论 (1)心脏起搏治疗严重缓慢性/快速性心律失常、心力衰竭患者具有提高生存率、改善生存质量、减少住院率、提高劳动能力等强大优势,并且技术上操作简单易行、安全、有效,随访简便,应大力推广普及;(2)进一步完善医疗保障制度,扩大医疗保险人群,使更多人群获益于心脏起搏治疗;(3)增强我国经济实力,加大资金、人力、技术投入研制开发出不同类型、功能齐全的心脏起搏器,降低治疗成本;(4)临床严格把握适应症,因病施治,降低并发症发生率,通过动态优化起搏系统延长起搏器寿命有助于心脏起搏治疗卫生经济学改观.Objective To research the cost of cardiac pacemaker presently in China,to evaluate the therapy of cardiac pacing from the perspective of medical economics,to use limited health resources reasonablly and to improve patients＇ long term survival quality.Methods The data of 687 patients who received cardiac pacemaker implantation in our hospital from January 2003 to December 2007 were collected.The basic conditions,primary diseases,grades of cardiac function,scores of life quality,types of pacemakers,cost of treatments and operations,and ways of payment of patients were recorded,and the scores of life quality of patiets,successive spending,complications and their impact on total cost were analyzed.Results All the 687 cases of operations got successful results（100% success rate）,but complications appeared in 9 cases（13%）and no death happened.Both of the cardiac function and the life quality of 564 patients,who were implanted pacemakers for the first time,were improved obviously.Pacmakers occupied the majority of direct cost.Among all the direct fees,cost of DDD was higher than VVI/AAI,that of ICD/CRT higher than DDD,and that of CRT-D higher than ICD/CRT,all differences had significant differences.The main mode of payment for treatment was the basic medical insurance and own expense for urban workers.Among all 687 patients,there were 390 patients enjoyed social basic medical insurance,40 patients enjoyed public health services and 257 patients at their own expense.The average life of pacemakers of AAI/VVI was longer than DDD,and that of DDD was longer than ICD/ CRT,all differences had significant differences.Conclusions（1）Cardiac pacemaker can improve the survival rate,improve the quality of life,reducing hospitalization rates and improve the ability to work and so on in the treatment of severe cardiac pacing slow/fast arrhythmia,and heart failure;at the same time the operation of technology is simple,safe,effective,and should be generalized.（2）Improved policy of medical care assurance and enlarged co

关 键 词：心脏起搏 疗效 卫生经济学 

分 类 号：R541[医药卫生—心血管疾病]