声门下分泌物引流用于预防呼吸机相关性肺炎的成本效益分析

Cost-Benefit Analysis of Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia

目的通过医学经济学方法了解声门下分泌物引流在预防呼吸机相关性肺炎中的成本-效益关系,以及该治疗措施对于患者的影响,为临床决策提供参考。方法采用队列研究的方法,187例预期通气时间超过48小时的机械通气的患者,按照时间顺序分为实验组和对照组,并通过历史对照比较两组患者的呼吸机相关性肺炎发生率,以及发生VAP患者的呼吸机治疗时间,ICU治疗时间,死亡率以及直接医疗成本。结果在实施间断声门下分泌物引流后,ICU机械通气患者VAP发生率显著下降;非VAP组较VAP组机械通气时间及ICU治疗时间均缩短,死亡率下降,该组患者相应的医疗支出明显减少;从长远角度来看,有效避免了不必要的医疗资源消耗。结论间断声门下分泌物引流在预防VAP中具有良好的临床效果及经济价值,值得在ICU推广。

Objective To study the benefit-cost relationship of subglottic secretion drainage in preventing ventilator-associated pneumonia by the medical economics, and the influence of the treatment to the patients, in order to provide a theoretical basis and reference for clinical strategy. Methods A cohort study was performed on 187 general ICU patients with a predicted ventilation time over 48 hours, who were divided into suction group and control group following the time sequence. Between the two groups, the incidence of ventilator-associated pneumonia, ventilatior and ICU treatment time, mortality rate, as well as direct medical costs were shown and compared by a historical control trial. Results The incidence of ventilator-associated pneumonia in ICU mechanical ventilation patients was significantly decreased after an intermittent subglottic secretion drainage, the ventilator and ICU treatment time of the patients without VAP was less than the patients with VAP, and the mortality rate was lower. It significantly showed cut the medical costs for patients, and effectively avoided unnecessary medical consumption in a long tenn. Conclusion Intermittent subglottic secretion drainage showed a good clinical efficacy and economic value in the prevention of VAP, and was wrothy of wide use in ICU.