肺癌肺叶切除术患者围手术期有无尿管留置的成本效益分析

Cost-effectiveness Analysis of Perioperative No Indwelling Urinary Catheter in Lung Cancer Patients with Pulmonary Lobectomy

目的分析肺癌患者围手术期不留置尿管的成本效益,以进一步确定不留置尿管的临床价值。方法前瞻性纳入2015年7~12月四川大学华西医院行肺癌肺叶切除术患者148例。按是否留置尿管将患者分为尿管留置组[74例,男45例、女29例,年龄（52.55±19.87）岁]和无尿管留置组[74例,男42例、女32例,年龄（54.03±16.66）岁],比较两组成本效益指标。结果无尿管留置组术后有5人次置尿管,尿管留置组81人次置尿管。两组患者尿管留置时间差异无统计学意义[（1.56±0.65）d vs.（1.68±0.91）d,P=0.077]。尿管留置组尿管材料费（4 811.48元vs.296.74元,P=0.045）、护理费用（7 413.32元vs.457.32元,P=0.013）及总费用（12 224.8元vs.754.06元,P=0.000）均高于无尿管留置组。尿管留置组护理总时间长于无尿管留置组（335.71 h vs.17.95 h,P=0.034）。尿管留置组人均材料费、护理费和总费用[（65.02±5.62）元/（次·人）vs.（4.01±0.00）元/（次·人）,（100.18±7.19）元/（次·人）vs.（6.18±1.22）元/（次·人）,（165.20±12.81）元/（次·人）vs.（10.19±1.22）元/（次·人）,P值均为0.000]均高于无尿管留置组。结论选择合适的肺癌患者围手术期无尿管留置不但节约费用且减少护理工作量。

Objective To investigate cost-effectiveness of no indwelling urinary catheter in pulmonary lobectomy patients and to confirm the advances of no indwelling urinary catheter.Methods We recruited 148 lung cancer patients who were scheduled for pulmonary lobectomy under general anesthesia in West China Hospital from July through December 2015.These patients were divided into two groups including an indwelling urinary catheter group（74 patients,45 males and 29 females,at age of 52.55±19.87 years） and a no indwelling urinary catheter group（74 patients,42 males and 32 females,at age of 54.03±16.66 years）.Indexes of cost-effectiveness of the two groups were compared.Results There was no statistical difference between the two groups in duration of indwelling catheter（1.56±0.0.65 d versus 1.68±0.91 d,P=0.077）.Material expense（4 811.48 yuan versus 296.74 yuan,P=0.045）,cost of nursing care（7 413.32 yuan versus 457.32 yuan,P=0.013）,and total expense（12 224.8 yuan versus 754.06 yuan,P=0.000） in the indwelling catheter group were higher than those in the no indwelling catheter group.Material expense per patient（65.02±5.62 yuan/patient-time versus 4.01±0.00 yuan/patient-time,P=0.000）,cost of nursing care per patient（100.18±7.19 yuan/patient-time versus 6.18±1.22 yuan/patient-time,P=0.000）,and total cost per patient（165.20±12.81 yuan/patienttime versus 10.19±1.22 yuan/patient-time,P=0.000） in the indwelling catheter group were higher than those in the no indwelling catheter group.Conclusion Both costs and labor of nurse can be cut down for appropriate lung cancer patients undergoing lobectomy without routine indwelling urinary catheter.