基层医院血液透析患者生存质量的调查分析

Survey and analysis of quality of life of hemodialysis patients in primary hospitals

目的分析基层医院血液透析患者的生存质量,及其与医疗费用消费之间的关系。方法选取本院2009年8月～2012年8月进行维持性血液透析的110例患者,根据其医疗费用支付方式将患者分为新型农村合作医疗(简称:新农合)组、医保组、公费医疗组(公医组)和自费组。对比4组患者的透析情况及生存质量。结果各组患者的年龄、性别比例差异无统计学意义(P>0.05),而新农合组及自费组患者的文化水平及月收入明显低于其他两组(P<0.05);在首次透析时间上公医<医保<新农合<自费,透析频率上公医>医保>新农合>自费,差异有统计学意义(P<0.05);新农合患者每月支付费用明显高于医保患者和公费医疗患者,自费患者每月支付费用明显高于其他3组患者,差异有统计学意义(P<0.05);各组患者的生存质量对比,公医组>医保组>新农合组>自费组,组间差异均有统计学意义(P<0.05)。结论随着新农合的应用及推广,维持性血液透析患者的透析次数逐渐增多,农村患者的生存质量有所提升,相对自费患者已经具有一定的优势,但与医保及公医患者仍有一定差距,经济压力较大,仍需要进一步完善新农合的医疗保障,给予农村血液透析患者更好的社会和经济支持,关注自费患者,人人享有医疗保障,提高维持性血液透析患者的生存质量。

Objective To analyze the quality of life of hemodialysis patients in primary hospitals and its correlation with medical expenses. Methods One hundred and ten cases of maintenance hemodialysis in the author＇s hospital from August 2009 to August 2012 were divided into new rural cooperative medical system （referred to a NCMS） group, health insurance group, free medical group （public medical group） and self-supporting group according to the medi- cal costs of payment. Dialysis situation and quality of life among the four groups were compared. Results Age and sex ratio showed no significant differences among the groups （P 〉 0.05）, while education level and the monthly income of the NCMS group and self supporting group were significantly higher than those of the other two groups （P 〈 0.05）; First dialysis time was significantly longer and dialysis frequency shorter in the order of public medical group, health insurance group, NCMS group and self supporting group （P 〈0.05）; Monthly pay of the NCMS group was significantly higher than those of the health insurance group and public medical group, while that of the self supporting group was significantly higher than those of the other three groups （P 〈 0.05）; Quality of life of patients was lower in the order of public medical group, health insurance group, NCMS group and self supporting group （P 〈 0.05）. Conclusion With the application and promotion of new rural cooperative medical system, the number of dialysis of maintenance hemodialysis patients increases gradually and the quality of life of rural patients has also improved and has certain ad- vantages over self supporting patients. However, there is still certain gap compared with health insurance and public medical, facing heavy economic pressure. Thus further improvement of the new rural cooperative medical insurance is needed to improve social and economic support for rural hemodialysis patients and also self supporting patients to guarantee equal medical insurance and improve quality of life of maintenance hemodialysis patients.