胸部X线摄片与腔内心电图定位PICC头端的卫生经济学评价  

Health economics evaluation on positioning tip of PICC catheter by chest radiography and intracavitary electrogram

作　　者：曹秀珠[1] 赵林芳[1] 金向红[1] 曾旭芬 Cao Xiuzhu;Zhao Linfang;Jin Xianghong;Zeng Xufen(Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou Zhejiang 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院,浙江杭州310016

出　　处：《护理与康复》2023年第3期12-16,共5页Journal of Nursing and Rehabilitation

基　　金：浙江省卫生健康科技计划临床研究应用项目,编号2022KY178;浙江省卫生健康科技计划适宜技术培育与推广项目,编号2022ZH035。

摘　　要：目的评价PICC置管后行胸部X线摄片定位导管头端和PICC置管中使用腔内心电图实时定位导管头端的卫生经济学效果。方法方便抽样选取PICC置管的肿瘤化疗患者247例,按不同院区使用不同的定位方法确定分组,胸部X线摄片定位组130例,腔内心电图定位组117例,采用成本效果分析对两种方法进行卫生经济学评价。两种定位方法的效果指标采用综合评分法,将两种定位方法未出现原发异位的比例、完成置管操作总时间、患者满意度、操作者满意度4类指标换算成一个综合效果指标作为总效果的代表值。结果胸部X线摄片定位组平均成本为(3022.34±61.95)元,腔内心电图定位组平均成本为(2974.96±37.74)元,t=-7.162,P<0.001。腔内心电图定位组置管效果中的导管未发生原发异位比例、操作者满意度达标比例、完成置管操作总时间达标比例优于胸部X线摄片定位组,两组差异有统计学意义。腔内心电图定位组综合效果指标为1.07,胸部X线摄片定位组综合效果指标为0.93。腔内心电图定位组成本效果比为2780.34,胸部X线摄片定位组成本效果比为3249.83。结论PICC置管采用腔内心电图定位导管头端技术成本效果好于胸部X线摄片定位,可作为独立的导管头端定位方法在临床应用。Objective To evaluate the health economics effect of positioning tip of PICC catheter by chest radiography after PICC catheterization and real-time positioning by intracavitary electrogram.Method Choose 247 tumor patients undergoing chemotherapy and PICC catheterization by convenient sampling and divide them into chest radiography positioning group(n=130)and intracavitary electrogram positioning group(n=117)according to different positioning methods in different hospital areas.Conduct health economics evaluation on two methods by cost-effectiveness analysis.Use comprehensive scoring method to convert the ratio without primary catheter migration,total time to complete catheterization,patients’satisfaction level and operators’satisfaction level into a comprehensive effect indicator as a representative value of the total effect of two positioning methods.Result The average cost of chest radiography positioning group is(3022.34±61.95)and the average cost of intracavitary electrogram positioning group is(2974.96±37.74),t=-7.162,P<0.001.The ratio without primary catheter migration,the standard rate of operators’satisfaction level and the standard rate of total time to complete catheterization are better in chest radiography positioning group than in intracavitary electrogram positioning group.The difference is significant.The comprehensive effect indicator is 1.07 in chest radiography positioning group and 0.93 in intracavitary electrogram positioning group.The cost-effectiveness ratio is 2780.34 in chest radiography positioning group and 3249.83 in intracavitary electrogram positioning group.Conclusion Positioning tip of PICC catheter by intracavitary electrogram has higher cost-effectiveness ratio than by chest radiography.Intracavitary electrogram can be used as an individual method in positioning tip of PICC catheter.

关 键 词：外周中心静脉导管 心电图 X线摄片 定位 成本 

分 类 号：R197.322[医药卫生—卫生事业管理]