超声引导下Seldinger PICC置管技术的卫生经济学评价

Health economic evaluation of ultrasound-guided Seldinger PICC placement

目的评价两种PICC置管方法的成本效果。方法随机抽取2009年5月至2011年4月自愿置管的患者319例，随机分为对照组175例和实验组144例，分别采用套管针穿刺法和超声引导下改良Seldinger穿刺法进行PICC置管，采用成本效果分析对两种置管方法进行卫生经济学评价。结果对照组带管期间未发生并发症比例、达到预期置管目的的比例及置管舒适度（61．7％，88．6％，44．6％）均低于实验组（97．2％，98．6％，76．4％），差异均有统计学意义（X。值分别为8．868，3．667，5．532；尸〈0．01）。对照组CER（2622，95）大于实验组（2164．08）；敏感度分析对照组CER（2436．23）大于实验组（2161．10），提示实验组的成本效果好于对照组。结论采用超声引导下Seldinger穿刺法PICC置管患者的舒适度更高，置管预期效果好，有良好的成本效果，适合临床推广应用。

Objective To evaluate the cost-effectiveness of two kinds of PICC placements. Methods 319 patients who were willing to receive PICC placement from May 2009 to April 2011 were selected and randomly divided into two groups： the experimental group （n = 144） and the control group （n = 175）. The control group received conventional technique of PICC placement while the experimental group received ultrasound-guided Seldinger PICC placement. Cost-effectiveness analysis was used to evaluate their health economics. Results The non-complications rate within the periods of inserting PICC, the rate of patients attaining the purpose of PICC placement and patients＇ were lower in the control group （61.7% ,88.6% and 44.6% ） than in the experimental group （97.2% ,98.6% and 76.4% ）, and the differences were statistically significant （t = 8. 868, 3. 667,5. 532, respectively; P 〈 0. 01 ）. Both CER and CER by sensitive analysis were higher in the control group （2 622. 95 and 2 436.23 ） than in the experimental group （2 164.08 and 2 161. 10 ）, suggesting that the cost-effectiveness was better in the experimental group than in the control group. Conclusions Patients＇ comfortable sense and intended placement effect prove to be better with ultrasound- guided Seldinger PICC placement, which has favorable cost-effectiveness and is worthy of clinical promoting.