极低出生体质量儿应用两种静脉输液途径效果评价及成本分析

Effects and costs of two different of intravenous infusion routes for very low birth weight infants

目的对极低出生体质量儿（VLBWI）应用外周静脉短导管（PIV）和经外周静脉置入中心静脉导管（PICC）两种输液途径进行效果评价及成本分析。方法选取2013年7月至2015年8月山西省长治市妇幼保健院新生儿重症监护室（NICU）95例应用PICC的VLBWI和同期90例留置PIV的VLBWI，分别作为PICC组和PIV组，比较两组患儿体质量增长、平均住院日、导管相关并发症发生率和护理成本及效果。结果两组患儿体质量增长比较，PICC组每周体质量增长高于PIV组，差异有统计学意义（P〈0．05）。两组患儿平均住院日比较，PICC组短于PIV组[（48．2±5．2）d比（53．2±8．1）d]，差异有统计学意义（P〈0．05）。两组患儿导管相关并发症发生率比较，PICC组（35．4％）低于PIV组（44．9％），其中静脉炎（PICC组21例次，PIV组169例次）、液体渗出或外渗（PICC组2例次，PIV组185例次）、导管脱出（PICC组3例次，PIV组145例次）差异有统计学意义（均P〈0．05）；导管堵塞（PICC组7例次，PIV组84例次）和其他（静脉穿刺栓塞、感染）（PICC组1例次，PIV组3例次）差异无统计学意义（均P〉0．05）。两种静脉输液途径成本比较，PICC月成本（1951．5元）稍低于PIV（2008．5元），单次成本（1691．5元）高于PIV（129．9元），PICC成本-效果比值（30．22）优于PIV（36．45）。结论对于VLBWI，PICC可减少患儿静脉穿刺次数，降低并发症发生率，促进患儿体质量增长。但单月成本两者相近，其原因可能与本研究观察时间过短有关，对于PICC，随着留置时间延长，其卫生经济学优点将更突出。

Objective To compare the effects and cost of peripheral intravenous catheter （PIV） and peripherally inserted central catheter （PICC） on very low birth weight infants （VLBWI） . Methods From July 2013 to August 2015, 95 VLBWI with PICC （PICC group） and 90 VLBWI with PIV （PIV group） admitted to the Neonatal Intensive Care Unit （NICU） of Changzhi Maternal and Child Care Hospital were included in the analysis. The two groups were compared in body mass increase, average length of hospital stay, incidence of catheter-related complications, and care cost and effect. Results The body mass increase per weak was higher in the PICC group than in the PIV group, with statistically significant difference （ P 〈 0.05 ）. The average length of hospital stay in the PICC group was shorter than that in the PIV group [ （48.2 ± 5.2）d vs. （53.2 ± 8.1 ） d, P 〈 0.05 ]. The incidence of catheter-related complications was lower in the PICC group than in the PIV group （35.4% vs. 44.9% ）, including phlebitis （PICC group, 21 person-times; PIV group, 169 person-times）, liquid leakage or exosmose （PICC group, 2 person-times; PIV group, 185 person-times）, and catheter prolapse （PICC group, 3 person-times; PIV group, 145 person-times） with statistically significant differences （ all P 〈 O. 05）, and catheter blockage （PICC group, 7 person-times; PIV group, 84 person-times） and other complica tions such as venous embolism and infection （PICC group, 1 person-time; PIV group, 3 person-times） with no statistically significant differences （all P 〉0.05）. The average monthly cost in the PICC group （1 951.5 yuan） was lower than that in the PIV group （2 008.5 yuan ） , and the cost of single insertion in the PICC group （ 1 691.5 yuan） was higher than that in the PIV group （ 129.9 ynan）, the cost-effectiveness was better in the PICC group than in the PIV group （30.22 vs. 36.45 ）. Conclusions For VLBWI, PICC can reduce the times of venous puncture, the incidence of complications, and promote body mass increase. However, the monthly cost was similar between the two groups in this study, possibly because of the short-time of this study. The advantages in cost-effectiveness of PICC may become more prominent when the catheter dwelling time extends.