缩短心脏起搏器患者手术住院日的安全性和费用分析

发布时间：2018-04-27 22:54

本文选题：心脏起搏器植入术 + 术后住院日　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:随着人口老龄化和起搏适应证的拓宽,心脏起搏器的植入数量日益增加,与植入相关的费用成为人们现在关注的重要问题。国外已进行了许多有关起搏器术后不同住院时间与住院费用、术后并发症发生率的关系的大型临床实验,而在我国相关研究较少。本回顾性研究的目的在于通过对不同住院时间的术后并发症及住院费用进行比较分析,探索缩短起搏器植入术住院日的安全性及费用问题,为国内相关研究提供依据。方法该研究选取了自2013年1月至2015年12月在青岛大学附属医院行起搏器植入的582例患者(包括单腔、双腔、ICD、CRT CRT-D的植入术和置换术),收集所有患者的基本资料及住院费用,分别于术后1月、3月、6月、12月进行随访,记录随访过程中出现的各种并发症。根据术后住院时间不同将其分为实验组(术后住院时间7天)和对照组(术后住院时间多7天),将两组一般基本资料、住院费用及术后并发症的发生率进行比较。结果(1)对照组114例患者和实验组468例患者的总平均住院费用分别为56649.7±24971.5(元)、76340.9 ±47426.3(元)(P0.05),对照组的住院费明显高于实验组。(2)实验组和对照组按照根据植入术的次数不同,分为初次植入,再次更换两个亚组,其中植入术亚组中实验组363例和对照组90例患者的平均住院费用为 59580.9 ±24225.2(元),85465.9 ±47294.4(P0.05),说明初次植入亚组对照组的住院费用明显高于实验组;置换术亚组实验组105例和对照组24例患者的平均住院费用为 46516.0±24974.0(元),42122.2 ±29116.4(元)(P=0.453,P0.05),说明起搏器更换亚组实验组和对照组住院费用无明显差别;(3)在随访的12个月中,实验组和对照组术后所有并发症总发生率分别为3.41%、4.39%P=0.59,说明两组所有并发症的总体发生率之间无差别;两组的各种并发症之间两两比较,P值均大于0.05,说明两组的各种并发症的发生率均无明显区别,两组各种并发症的分布方面P=O.96,P值大于0.05,说明说明两组术后并发症的构成分布无明显区别。结论(1)缩短心脏起搏器患者住院日明显降低初次植入起搏器患者的住院费用,对于再次置换起搏器患者,缩短心脏起搏器患者住院时间,住院费用无明显差异。(2)缩短心脏起搏器植入术的住院日,总的手术相关并发症及各种术后并发症发生率均无明显差异,保证了心脏起搏器植入术的安全性。(3)本研究说明缩短心脏起搏器植入术的住院日,在保证不增加术后并发症发生率的前提下,减少初次植入起搏器患者的经济费用,明显减轻医疗保健系统及患者家庭的经济负担,同时为心脏起搏器植入术日间手术模式在国内的进一步的推广提供一些依据。
[Abstract]:Objective: with the aging of the population and the widening of pacing indications, the number of cardiac pacemakers is increasing day by day, and the cost associated with implantation has become an important issue that people pay attention to. Many large clinical experiments have been conducted in foreign countries on the relationship between different hospital stay time after pacemaker operation and the cost of hospitalization and the incidence of postoperative complications, but there are few related studies in our country. The purpose of this retrospective study is to explore the safety and cost of shortening the hospitalization days of pacemaker implantation by comparing and analyzing the postoperative complications and hospitalization costs of different hospital stay, and to provide the basis for the relevant research in China. Methods from January 2013 to December 2015, 582 patients (including single-chamber, double-chamber CRT CRT-D implantation and replacement) in the affiliated Hospital of Qingdao University were selected to collect the basic data and hospital expenses. All kinds of complications were recorded at 1 month, 3 months, 6 months and 12 months after operation. The patients were divided into experimental group (7 days after operation) and control group (7 days after operation) according to the different hospitalization time after operation. The general data, hospital expenses and the incidence of postoperative complications were compared between the two groups. Results 1) the total average hospitalization expenses of the control group and the experimental group were 56649.7 卤24971.5 (RMB 76340.9 卤47426.3) and the hospitalization cost of the control group was significantly higher than that of the experimental group. According to the times of implantation, the experimental group and the control group were divided into the first implantation according to the times of implantation. The average hospitalization expenses of the experimental group and the control group were 59580.9 卤24225.2 and 85465.9 卤47294.4 respectively, which indicated that the hospitalization cost of the control group was significantly higher than that of the experimental group. The average hospitalization cost of the two groups was 46516.0 卤24974.0 (42122.2 卤29116.4), indicating that there was no significant difference between the pacemaker replacement subgroup and the control group. The total incidence of all postoperative complications in the experimental group and the control group was 3.41 and 4.39P0.59 respectively, indicating that there was no difference in the overall incidence of all complications between the two groups. There was no significant difference in the incidence of complications between the two groups, and the P value of the two groups was greater than 0.05, indicating that there was no significant difference in the incidence of complications between the two groups. The distribution of complications in the two groups was more than 0.05, indicating that there was no significant difference in the composition and distribution of postoperative complications between the two groups. Conclusion 1) shortening the hospitalization days of patients with pacemaker can significantly reduce the hospitalization cost of patients with pacemaker implantation for the first time, and shorten the hospitalization time of patients with pacemakers after replacement of pacemakers, and shorten the hospitalization time of patients with pacemakers after replacement of pacemakers. There was no significant difference in hospitalization cost. (2) there was no significant difference in the total operation-related complications and the incidence of various postoperative complications during cardiac pacemaker implantation. This study shows that shortening the hospitalization days of pacemaker implantation and reducing the economic cost of the first pacemaker implantation without increasing the incidence of postoperative complications. The financial burden of the medical care system and the patients' families is obviously reduced, and the basis for the further promotion of pacemaker implantation in China during the daytime operation is provided.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7

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