求医方式对小儿急性阑尾炎卫生经济学的影响  

Influence of Different Ways to Seek Medical Help on Health Economics of Acute Appendicitis in Children

作　　者：周汝宝 张杉杉 王宁 李娜 申伟 张远圆 何杰 吴学东 Zhou Rubao;Zhang Shanshan;Wang Ning;Li Na;Shen Wei;Zhang Yuanyuan;He Jie;Wu Xuedong(Department of Pediatric Surgery,The First Affiliated Hospital and Clinical Medical Research Center of Dali University,Dali,Yunnan 671000,China)

机构地区：[1]大理大学第一附属医院暨临床医学研究中心小儿外科

出　　处：《大理大学学报》2020年第2期12-16,共5页Journal of Dali University

基　　金：云南省医学领军人才培养项目(L-2017026)

摘　　要：目的:探讨求医方式(首诊、转诊)对小儿急性阑尾炎卫生经济学的影响。方法:根据求医方式包括首诊和不同转诊单位数将2013年1月至2016年12月大理大学第一附属医院收治并行手术治疗的292例急性阑尾炎患儿分成四组,分别是第一组首诊79例、第二组经过1次转诊137例、第三组经过2次转诊66例和第四组经过3次及以上转诊10例,通过方差、t检验和χ^2检验比较分析病程、阑尾穿孔率、术后并发症发生率、住院时间和住院费用,Logistic回归对指标间的相关性进行分析。结果:从第一组到第四组各项指标分别是:①病程(36.27±24.85)h、(57.05±40.53)h、(95.10±63.29)h和(105.60±27.36)h;②阑尾穿孔率17.72%、38.69%、53.03%和90.00%;③术后并发症发生率2.53%、14.60%、24.24%和80.00%;④住院时间(6.82±2.54)d、(8.78±4.32)d、(12.03±5.27)d和(18.00±8.60)d;⑤住院费用(3927.66±945.46)元、(4563.03±1217.61)元、(6056.31±1909.70)元和(9802.49±2551.49)元。从首诊到转诊和多次转诊,各指标增多趋势明显,除病程在第三组和第四组间的差异无统计学意义(P>0.05)外,其余各指标组间比较差异均有统计学意义(P<0.05)且相互间存在正相关关系(P=0.000),Logistic回归P<0.05。结论:小儿急性阑尾炎从首诊到多次转诊,由于病程延长,阑尾穿孔率和术后并发症发生率增加、住院时间延长,从而导致住院费用增加,建议急性阑尾炎患儿尽量在首诊医院治疗,减少转诊次数不仅可以缩短病程,也可以缩短住院时间和减少医疗费用。Objective:To explore the influence of different ways to seek medical help(first visit or referral)on health economics of acute appendicitis in children.Methods:292 children with acute appendicitis were divided into four groups according to the ways to seek medical help(first visit or referral)in the First Affiliated Hospital of Dali University from January 2013 to December 2016.In Group 1,there were 79 cases of the first visit;in Group 2,there were 137 cases of referral for once;in Group 3,there were 66 cases of referral for twice;and in Group 4,there were 10 cases of referral for at least three times.The values including the time period of disease course,ratio of appendiceal perforation and postoperative complications,duration and cost of hospitalization were compared and analyzed with t-Test,χ^2 and Logistic in different groups.Results:From Group 1 to Group 4,relevant data was:①disease course(36.27±24.85)h,(57.05±40.53)h,(95.10±63.29)h and(105.60±27.36)h;②the ratio of appendiceal perforation 17.72%,38.69%,53.03%and 90.00%;③the ratio of postoperative complications 2.53%,14.60%,24.24%and 80.00%;④hospital days(6.82±2.54)d,(8.78±4.32)d,(12.03±5.27)d and(18.00±8.60)d;⑤hospital costs(RMB 3927.66±945.46),(RMB 4563.03±1217.61),(RMB6056.31±1909.70)and(RMB 9802.49±2551.49)respectively.From the first diagnosis to the referral and multiple referrals,there were significant increases in all indicators.Except for the difference in disease course between Group 3 and Group 4(P>0.05),there were statistically significant differences among other indicators between different groups(P<0.05)and there was a positive correlation between different indicators(P=0.000).Logistic regression was P<0.05.Conclusion:Hospital costs increased in children with acute appendicitis due to the increase of the appendiceal perforation rate,the postoperative complications rate and the length of hospital stay with the prolong of illness course because of the different option for seeking medical help ways from first visit to one or m

关 键 词：急性阑尾炎 求医方式 首诊 转诊 卫生经济学 儿童 

分 类 号：R726[医药卫生—儿科]