创伤性鼓膜穿孔不同疗法治疗效果及医疗成本分析

Comparative Analysis on Medical Expenses and Effect on Different Treatment of Traumatic Perforation of Tympanic Membrane

目的分析创伤性鼓膜穿孔患者不同疗法治疗效果及直接医疗成本的组成,为减轻患者医疗费用提供科学依据。方法 137例创伤性鼓膜穿孔患者依据费用来源及经济状况分为A、B、C3组,分别采用保守治疗、贴片修复及耳内镜手术,观察穿孔愈合情况并计算医疗成本。结果 A、B、C组患者穿孔愈合率分别为91.49%、84.21%、82.69%,差异无统计学意义(P>0.05)。穿孔平均愈合时间分别为(27.4±4.6)、(19.3±2.7)、(17.5±1.8)d,差异有统计学意义(P<0.05)。A组感染发生率较C组明显降低,差异有统计学意义(P<0.05);平均直接医疗成本分别为(870±720)、(1750±900)、(2250±800)元,差异有统计学意义(P<0.05)。结论创伤性鼓膜穿孔患者采取保守治疗、贴片干预及内镜手术治愈率无差异,虽然保守治疗愈合时间较长但感染发生率及平均直接医疗成本明显减少,临床应首先采取保守治疗,效果不佳时可进一步采用贴片干预及内镜手术方法治疗,以减少医疗成本。

Objective Composition analysis of direct medical costs of different treatment for traumatic perforation of tympanic membrane and provide scientific basis for reduceing medical cost.Methods 137 patients of traumatic perforation of tympanic membrane were divided into 3 groups（A,B,C） by expenses origin and economic status,adopted take conservative treatment 47 cases,34.31%,pain treatment 38 cases,27.74% and Endoscopic ear surgery 52 cases,37.96%.observing the healing of traumatic perforation and calculating the medical costs after a month.Results The healing rat of three groups were 91.49%,84.21% and 82.69% respectively,the healing time of three groups were （27.4±4.6）,（19.3±2.7）,（17.5±1.8）d,medical costs were（870±720）,（1 750±900）,（2 250±800）yuan respectively in three groups.The healing rat have not significant difference between them（P0.05）.A group was delays healing one week than Bgroups and C groups.The healing time have significant difference between them（P0.05）.Conclusion Patients should of traumatic tympanic membrane perforation conservative treatment,intervention and patch endoscopic cure rate with zero error,although the healing time longer,but infection rate and average direct medical costs are significantly reduced,clinical treatment should be conservative first,The poor results further intervention and endoscopic surgery with patch method to reduce health care costs.