重症监护病房内床边钳扩气管切开术的成本效益比及安全性研究

The cost-efficiency and safety of bedside forceps dilatational tracheostomy in the intensive care unit

目的 探讨重症监护病房（ICU）医师行床边钳扩气管切开术（FDT）的效率、安全性和成本效益比.方法 为83例需长期保留人工气道的ICU患者行床边FDT,统计分析FDT从临床决定到执行的时间、手术耗时、手术费用以及术中和术后并发症.与同期102例本院手术室行外科气管切开术（ST）患者的平均费用进行比较.结果 83例患者成功完成FDT;FDT从临床决定到执行的时间为（11.5±8.5） h,手术耗时（14.5±5.5） min,手术费用（1 560±340）元;手术费用低于同期本院手术室102例行ST患者的平均费用（2 600±450）元（P〈0.05）.83例患者FDT术中、术后并发症发生率分别为15.66%和2.41%;术后28 d死亡9例.结论 ICU内床边FDT安全、高效,具有较好的成本效益比.

Objective To study the cost-efficiency and safety of bedside forceps dilatational tracheostomy （FDT） in the intensive care unit （ICU）. Methods FDT was performed in 83 patients who needed prolonged artificial airway. The time interval between the decision and actual time of operation, time for completing the procedure, operation cost, perioperative and postoperative complications were recorded and analyzed. The operation cost was compared between 83 FDT cases and other 102 surgical tracheostomy （ST） cases which were performed in the operation room during the same period. Results FDT was sucessfully perfomed for 83 patients. The average time interval between the decision and undertaking FDT was （11.5±8.5） hours, the average operating time was （14.5±5.5） minutes, the operation cost of FDT [（1 560±340） yuan] was lower than that of ST [（2 600±450） yuan, P〈0.05]. The incidence of the perioperative and postoperative complication of the 83 patients was 15.66% and 2.41% respectively. Nine patients died within 28 days after FDT. Conclusion FDT performed by intensivists for critically ill patients in ICU is safe and cost-effective.