2003-2008年重庆主城区医院白内障手术现状调查及相关因素分析

发布时间：2018-05-02 22:41

本文选题：白内障 + 手术　；参考：《第三军医大学》2011年博士论文

【摘要】：背景白内障为全球致盲眼病的主要原因。在我国约有250万人因白内障致盲,占全球白内障致盲总数的10%。随着人口的老龄化,预计我国每年新增白内障患者将超过100万,而我国的白内障年手术量尚不足以解决每年的新增例数。因此,我国的白内障盲防治问题十分严峻。1999年世界卫生组织(WHO)指出当时(1999年)我国白内障手术率(cataract surgery rate, CSR)在百万人口中仅有270例,仅比非洲的CSR(200例)略多,而发达国家的CSR为3000～5000例,印度为3100例,东欧国家CSR为800～3000例。近年来,我国在“视觉第一中国行动”及“视觉2020,享有看得见的权利”行动的推动下,在中国残联、卫生部及国内外非政府组织的领导及支持下,CSR明显提高,2004年达到448.7例。但与发达国家相比,仍存在巨大差距,就连和我们经济及人口相当的印度相比,差距也非常显著。而且,同年重庆市的CSR却只有217.4例,不及全国平均水平的一半,排名倒数第二。重庆作为中国最年轻的直辖市,其CSR却如此低下是值得深思的一个重要问题。尽管政府通过大量的工作,如:提供部分补助、慈善机构免费手术等以求改变这种CSR低下的状况,由于需要手术治疗的患者量太大,且并非每位患者都能享受到这种福利待遇,白内障盲防治工作任重道远。2003年,政府决定全面实施医改,为广大群众提供基本医疗服务。那么,作为我国政府做出承诺并积极参与“视觉2020,享有看得见的权利”这一全球性防盲治盲目标中的首要任务——白内障盲的防治,医改对其是否产生影响?又会产生怎样的影响?目前尚未见相关文献报道。近年来,国家的白内障盲防治重点在于农村患者,这极大的促进了农村白内障盲的防治工作,但在临床工作中,我们发现有相当多重庆城镇老年性白内障患者在白内障成熟期、甚至过熟期视力极差的情况下,仍未接受手术治疗,究其原因并非经济困难及医疗条件的限制。那么,到底是什么原因导致重庆城镇白内障患者延迟手术?随着农村城市化和人口老年化的发展,将会有越来越多的城镇白内障患者,这部分患者能否及时手术,恢复视功能,也是一个不可忽视的问题。因此,了解重庆市医疗机构白内障手术现状和相关影响因素,对加快重庆的白内障盲防治进程具有重要意义。目的在调查2003-2008年间重庆主城区医院年龄相关性白内障手术现状及分析相关影响因素的基础上,了解医疗体制改革对重庆市年龄相关性白内障手术的影响,并分析重庆城镇年龄相关性白内障患者延迟手术的原因,以期为加快重庆白内障盲防治工作提供借鉴和参考。研究对象与方法 1.样本来源:采用多级整群抽样从重庆主城9区中随机抽取6区,在此6区中再随机抽取其内所辖的8所医院,即:第三军医大学大坪医院、重庆医科大学附属第二医院、武警重庆总队医院、重庆市第三人民医院及重庆江北区第一人民医院、重庆沙坪坝区第一人民医院、重钢总医院、重庆建设厂职工医院,进行研究。 2.资料收集和分析: ⑴.收集上述8所医院中于2003年1月1日至2008年12月31日因年龄相关性白内障而接受手术治疗的所有病例,回顾分析患者一般情况(来源、性别、年龄、术前最佳矫正视力、晶状体核硬度、是否享有医疗保险)以及手术量、患者所选用手术方式、所选用人工晶状体的类型、医师一期人工晶体植入率等指标,了解重庆市白内障手术现状和相关影响因素。 ⑵.收集上述8所医院中于2003年1月1日至2008年12月31日因年龄相关性白内障而接受手术治疗的所有重庆籍患者手术量、所选用的手术方式、所选用的人工晶状体和享受医疗保险情况,分析医疗体制改革对白内障手术量、手术方式、所选用人工晶状体的影响。 ⑶.通过对自2008年1月1日至2008年12月31日间于上述八所医院在白内障成熟期及过熟期时方行手术(即延迟手术)的重庆城镇患者进行问卷调查,了解患者延迟手术的原因。结果 1. 2003-2008年间重庆市主城区医院白内障手术现状: ⑴.手术量逐年增加,以城镇患者为主,但农村患者所占比例逐年提高; ⑵.患者接受手术的时间逐渐提前,表现为接受手术的年龄呈年轻化趋势,接受手术时最佳视力逐渐增高,晶状体核硬度逐渐降低; ⑶.超声乳化白内障吸除术已成为患者接受白内障手术的主要术式; ⑷.人工晶状体的选择以非折叠型为主,但折叠人工晶状体的比例逐年增加;⑸.白内障医生一期人工晶状体植入率明显提高。 2.医疗体制改革对重庆籍年龄相关性白内障患者手术的影响: (1)医疗体制改革对白内障手术量的影响:2003-2008年间,主城区医院白内障手术量逐年增加,享有医疗保险患者手术量亦逐年增加,二者呈高度正相关性(r=0.971, p=0.0010.05)。 (2)医疗体制改革对白内障患者选择手术方式的影响:2003-2008年间,主城区医院选择超声乳化白内障手术方式的手术量逐年增加,享有医疗保险患者手术量亦逐年增加,二者呈高度正相关性(r=0.985,P=0.0000.05)。享有医疗保险的患者选择超声乳化白内障的比例明显高于未享有医疗保险的患者(p0.001)。 (3)医疗体制改革对白内障患者选择人工晶状体的影响:2003-2008年间,主城区医院白内障患者选择折叠人工晶状体的量逐年增加,享有医疗保险患者手术量亦逐年增加,二者呈高度正相关性(r=0.984,P=0.0000.05)。享有医疗保险的患者选择折叠人工晶状体的比例明显高于未享有医疗保险的患者(p0.001)。 3.重庆城镇年龄相关性白内障患者延迟手术的问卷调查:对于重庆城镇患者而言,经济因素不是延迟手术的主要原因,而“认为白内障不成熟不能手术”、“因尚能视物而暂不愿行白内障手术”、“不知道自己患白内障”分别为延迟手术的三大原因;延迟手术的时间与患者的年龄,是否享有医疗保险及是否每年进行眼科体检有关(p0.05)。结论 1. 2003-2008年间,重庆市主城区医院年龄相关性白内障手术量逐年增加,农村患者所占比例明显提高;白内障患者,尤为城镇患者,对视觉质量的要求逐年提高;白内障医生的手术技能明显提高。这与6年来重庆市国民经济快速发展、医改不断完善、医疗条件的改善、市民自我防护和眼保健意识有所增强密切相关。 2.医改是影响重庆籍白内障患者能否接受手术、选择手术方式和人工晶状体类型的一个重要因素。参保的患者更易接受手术,选择更好的超声乳化手术方式及折叠人工晶状体。说明医改不仅有利于白内障盲防治,还有利于提高白内障患者的视觉质量。 3.在城镇患者中延迟手术治疗的时间与患者性别、学历、年收入无关,而和患者年龄、是否享有医疗保险、是否参加眼部体检有关。对50岁以上人群每年进行眼部体检,扩大医保的覆盖范围和支持力度,同时加强白内障科普知识宣传,是加速重庆城镇白内障盲防治工作的重要措施。
[Abstract]:Background

In recent years , China ' s cataract surgery rate ( CSR ) is estimated to be more than 1 million because of cataract blindness , which accounts for 10 % of global cataract blindness .

Although the government has adopted a great deal of work , such as the provision of partial subsidies , the free operation of charities and so on in order to change the state of the low CSR , the government has decided to implement the reform in a comprehensive way and provide basic medical services for the broad masses . In 2003 , the government decided to fully implement the reform and provide basic medical services for the broad masses .

In recent years , the focus of cataract blindness prevention in the country is the rural patient , which greatly promotes the prevention and cure of cataract blindness in rural areas . However , in the clinical work , we have found that there are quite a lot of senile cataract patients in Chongqing .

Therefore , it is very important to understand the present situation of cataract surgery in Chongqing medical institutions and the related factors , and to speed up the cataract blindness prevention and control process in Chongqing .

Purpose

On the basis of investigating the present situation and influencing factors of age - related cataract surgery in Chongqing ' s main urban area between 2003 and 2008 , this paper analyzes the influence of medical system reform on age - related cataract surgery in Chongqing , and analyzes the causes of delayed operation of age - related cataract patients in Chongqing , with a view to providing reference for speeding up the prevention and treatment of cataract blindness in Chongqing .

Research objects and methods

1 . Sample source : A multi - level cluster sampling is adopted to randomly extract 6 districts from 9 districts of Chongqing main city , and 8 hospitals under their jurisdiction are randomly selected in the 6 districts , namely , the Third Military Medical University , the Second Affiliated Hospital of Chongqing Medical University , Chongqing General Hospital of Chongqing Medical University , the Third People ' s Hospital of Chongqing and the First People ' s Hospital in Jiangbei District of Chongqing , the First People ' s Hospital of Shapingba District of Chongqing , the General Hospital of Heavy Steel , and the Staff Hospital of Chongqing Construction Plant .

2 . Data collection and analysis :

( 1 ) Collect all the cases in the above - mentioned eight hospitals from January 1 , 2003 to December 31 , 2008 due to age - related cataract , and review the general situation of the patients ( source , sex , age , preoperative best corrected vision , lens nucleus hardness , whether or not to have medical insurance ) as well as the amount of operation , the mode of operation selected by the patient , the type of the intraocular lens selected , the implantation rate of the first - stage intraocular lens , and the related factors .

( 2 ) To collect the operation amount of all Chongqing patients who received surgery from January 1 , 2003 to December 31 , 2008 due to age - related cataract in the eight hospitals mentioned above , the surgical mode selected , the selected intraocular lens and the medical insurance coverage , and analyze the influence of medical system reform on cataract surgery amount , operation mode , and selected intraocular lens .

( 3 ) To investigate the causes of delayed operation of patients by means of a questionnaire survey of Chongqing urban and town patients from January 1 , 2008 to December 31 , 2008 , during cataract maturity and over - mature period ( i.e . , delayed surgery ) .

Results

1 . Status of cataract surgery in main urban areas of Chongqing during 2003 - 2008 :

( 1 ) The proportion of operation increased year by year , mainly in town patients , but the proportion of rural patients increased year by year ;

( 2 ) The time of the patient receiving the operation gradually advanced , showing that the age of the operation was younger , the best visual acuity was gradually increased at the time of surgery , and the hardness of the nucleus of the lens gradually decreased ;

( 3 ) phacoemulsification with phacoemulsification has become the main surgical procedure for patients with cataract surgery ;

( 4 ) The selection of intraocular lens was the main non - folding type , but the proportion of foldable intraocular lens increased year by year ; ( 5 ) The implantation rate of intraocular lens increased significantly in the first stage of cataract .

2 . Effect of medical system reform on operation of patients with age - related cataract in Chongqing :

( 1 ) The effect of medical system reform on cataract surgery was that in 2003 - 2008 , the operation volume of cataract surgery increased year by year , and the operation volume of patients with medical insurance increased year by year . Both were highly positive ( r = 0.9971 , p = 0.0010 . 05 ) .

( 2 ) The effect of medical system reform on the choice of operation mode of cataract patients : In 2003 - 2008 , the operation volume of choosing phacoemulsification cataract surgery increased year by year , and the operation volume of patients with medical insurance increased year by year . Both were highly positive ( r = 0.985 , P = 0.0000.05 ) . The proportion of patients with medical insurance selected for phacoemulsification was significantly higher than those without medical insurance ( p0.001 ) .

( 3 ) The effect of medical system reform on the choice of intraocular lens in cataract patients : in 2003 - 2008 , the amount of foldable intraocular lens increased year by year , and the operation volume of patients with medical insurance increased year by year , with positive correlation between them ( r = 0.984 , P = 0.0000.05 ) . The proportion of patients who had access to health insurance was significantly higher than those who did not have medical insurance ( p0.001 ) .

3 . Questionnaire of delayed operation of age - related cataract patients in Chongqing : For Chongqing urban patients , economic factors are not the main causes of delay surgery , and " cataract surgery is not considered to be performed in cataract surgery " , " it is not known that cataract surgery " is the three major causes of delayed surgery , and whether the time of delay surgery is related to the age of the patient , whether it is entitled to medical insurance and whether to carry out ophthalmological examination every year ( p . 05 ) .

Conclusion

1 . In the period of 2003 - 2008 , the age - related cataract operation in the main urban areas of Chongqing increased year by year , and the proportion of patients in rural areas was obviously improved ; cataract patients , especially in urban areas , had improved the visual quality ; the operation skills of cataract doctors increased significantly . This was closely related to the rapid development of the national economy in Chongqing in the past six years , the improvement of medical reform , the improvement of medical conditions , the self - protection of the public and the enhancement of eye health awareness .

2 . The medical reform is an important factor which affects the operation , choice of operation mode and the type of intraocular lens in patients with cataract in Chongqing . It is easier to accept the operation and choose the better mode of phacoemulsification and foldable intraocular lens .

3 . The time of delay surgery in urban patients is not related to the patient ' s gender , educational background and annual income , regardless of age of the patient , whether it has medical insurance or whether to take part in the medical examination of the eye . For more than 50 years old , the medical examination should be carried out to enlarge the coverage and support of medical insurance . At the same time , it is an important measure to speed up the prevention and control of cataract blindness in Chongqing .

【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R779.66

【参考文献】