AngioJet机械吸栓与置管溶栓治疗下肢深静脉血栓的成本效益分析  

Cost-effectiveness analysis of AngioJet mechanical thrombectomycompared to catheter-directed thrombolysis for the treatment oflower extremity deep vein thrombosis

作　　者：李观强 孙元 张静波[2] 张喜成[1] LI Guanqiang;SUN Yuan;ZHANG Jingbo;ZHANG Xicheng(Department of Vascular Surgery and Intervention,Dushu Lake Hospital Affiliated to Soochow University,Suzhou,Jiangsu 215000,China;Department of Cardiovascular Surgery,Baoding First Central Hospital,Baoding,Hebei 071000,China;Department of Vascular Surgery,Subei People's Hospital,Yangzhou,Jiangsu 225000,China)

机构地区：[1]苏州大学附属独墅湖医院血管外科与介入科,江苏苏州215000 [2]河北省保定市第一中心医院心脏血管外科,河北保定071000 [3]苏北人民医院血管外科,江苏扬州225000

出　　处：《中国普通外科杂志》2023年第6期859-866,共8页China Journal of General Surgery

摘　　要：背景与目的:下肢深静脉血栓(DVT)是住院患者常见的并发症,目前对其治疗倾向于快速清除血栓,以减少血栓后遗症的出现。方法主要包括导管接触性溶栓(CDT)及经皮机械性血栓清除术(PMT),但对CDT和PMT的适应证仍有一定争议,卫生经济学方面也缺少相关研究,无法衡量CDT和PMT治疗方法使患者受益的情况。本研究旨在通过分析接受外科治疗的下肢DVT患者来综合评估比较CDT和AngioJet两种治疗方式对患者的获益情况,为临床医生选择合适的治疗方式提供一些建议,使患者在疗效、生活、经济上能够得到最大的获益。方法:收集苏北人民医院血管外科2018年12月—2020年8月确诊下肢DVT并接受CDT或AngioJet方式治疗的患者临床与随访数据,分析疗效(证候积分)、成本效益,以及随访彩超复查结果、Villalta评分及CIVIQ-2评分。结果:共纳入79例下肢DVT患者,其中AngioJet治疗47例(AngioJet组),CDT治疗32例(CDT组)。两组患者一般资料与耗材使用情况差异均无统计学意义(均P>0.05)。两组治疗后症状均明显好转,AngioJet组痊愈率高于CDT组(34.04%vs.12.50%, P<0.05),两组住院时间无明显差异(P>0.05),AngioJet组住院费用明显高于CDT组(77 498.11元vs. 66 092.58元,P<0.05),但AngioJet组每达到1%的痊愈率的费用低于CDT组(2 579.83元vs. 5 287.41元)。两组术后随访彩超复查评分差异无统计学意义(P>0.05),但Villalta评分及CIVIQ-2评分均显示,AngioJet组治疗效果均优于CDT组(均P<0.01)。结论:AngioJet及CDT均可有效地治疗下肢DVT,AngioJet对于下肢DVT患者来说是卫生经济效益较高的治疗方式,同时提供患者更好的生活质量。经济允许情况下可考虑选用AngioJet治疗方式。Background and Aims:Lower extremity deep vein thrombosis(DVT)is a common complication in hospitalized patients.The current approach to its treatment focuses on rapid thrombus removal to reduce the occurrence of post-thrombotic syndrome.The main methods include catheter-directed thrombolysis(CDT)and mechanical thrombus removal(PMT).However,there is still some controversy regarding the indications for CDT and PMT,and there needs more relevant research in health economics,making it difficult to assess the benefits of CDT and PMT treatments for patients.This study aims to comprehensively evaluate and compare the benefits of CDT and AngioJet treatments in patients with lower extremity DVT who underwent surgical treatment in order to provide recommendations for clinical doctors in selecting appropriate treatment methods and maximize the benefits for patients in terms of efficacy,quality of life,and economics.Methods:Clinical and follow-up data were collected from patients diagnosed with lower extremity DVT and treated with CDT or AngioJet in the Department of Vascular Surgery from December 2018 to August 2020.The analysis included efficacy(syndrome scores),cost-effectiveness,follow-up color Doppler ultrasound results,Villalta scores,and CIVIQ-2 scores.Results:A total of 79 patients with lower extremity DVT were included,with 47 patients treated with AngioJet(AngioJet group)and 32 patients treated with CDT(CDT group).There were no significant differences in general characteristics and consumable usage between the two groups of patients(all P>0.05).Symptoms significantly improved in both groups after treatment,with a higher recovery rate in the AngioJet group compared to the CDT group(34.04%vs.12.50%,P<0.05).There was no significant difference in the length of hospital stay between the two groups(P>0.05).The treatment cost was significantly higher in the AngioJet group compared to the CDT group(77498.11 CNY vs.66092.58 CNY,P<0.05).However,the cost per 1%recovery rate was lower in the AngioJet group compared to the CDT gr

关 键 词：静脉血栓形成 下肢 机械溶栓 血栓切除术 费用效益分析 

分 类 号：R654.3[医药卫生—外科学]