小儿室间隔缺损超快通道手术的经济效益分析(1)
[摘要]目的 探讨小儿室间隔缺损通过超快通道手术带来的经济效益。方法 选取2015年5～7月在我院行超快通道室缺修补术的53例室间隔缺损患儿作为超快通道组，选取2014年5～7月在我院行传统室间隔缺损修补术的65例室间隔缺损患儿作为传统手术组。比较两组的住院时间、住院费用、床位利用率及监护室停留时间，评价超快通道手术在室间隔缺损修补术中的经济效益。结果 超快通道手术组的住院时间、监护室停留时间显著短于传统手术组，住院费用少于传统手术组，床位利用率低于传统手术组，差异有统计学意义(P<0.01或P<0.05)。结论 小儿室间隔缺损采用超快通道手术较传统手术方式具有更好的经济效益。
[关键词]超快通道手术；体外循环；室间隔缺损；经济效益
[中图分类号] R725.4 [文献标识码] A [文章编号] 1674-4721(2016)09(b)-0080-03
.Methods 53 children with ventricular septal defect underwent ultra fast channel ventricular septal defect repair in our hospital from May to July in 2015 in our hospital were selected as the super fast track group，65 children with ventricular septal defect underwent traditional repair of ventricular septal defect in our hospital from May to July in 2014 in our hospital were selected as the traditional operation group.The length of stay，the cost of hospitalization，the utilization rate of the bed and the residence time of the monitoring room in the two groups was compared，the economic benefit of ultra fast track surgery in the repair of ventricular septal defect was evaluated.Results The length of stay，the residence time of the monitoring room in the super fast track group was shorter than that in the traditional operation group，the cost of hospitalization in the super fast track group was less than that in the traditional operation group，the utilization rate of the bed in the super fast track group was shorter than that in the traditional operation group，with significant difference (P<0.01 or P<0.05).Conclusion The economic benefits of ultra fast track surgery in the treatment of pediatric ventricular septal defect is better than that the traditional operation method.
[Key words]Ultra fast track surgery；Extracorporeal circulation；Ventricular septal defect；Economic benefit
室间隔缺损属于小儿常见的一种先天性心脏病，在全部先天性心脏病发生率中占20%[1]。超快通道麻醉技术主要是指选择恰当的麻醉药物及方法，在快速通道上使患儿术毕即刻进行气管拔管或在术后1 h内进行拔管，以缩短患儿的机械通气时间及在监护室停留时间，在有效减少患者住院费用的同时，也有利于患儿的恢复[2]。本研究主要分析小儿室间隔缺损超快通道手术的经济效益，现报道如下。
1资料与方法
1.1一般资料
选取2015年5～7月在我院行超快通道室缺修补术的53例室间隔缺损患儿作为超快通道组，其中男33例，女20例；年龄43 d～5岁，平均(2.85±0.58)岁；体重6.3～18.0 kg，平均(10.85±1.47)kg。选取2014年5～7月在我院行传统室间隔缺损修补术的65例室间隔缺损患儿作为传统手术组，其中男41例，女24例；年龄53 d～6岁，平均(2.91±0.57)岁；体重8.8～16.0 kg，平均(10.87±1.43)kg。术前所有患儿均无呼吸道感染，无其他脏器并发症，无严重肺动脉高压；手术组医生、麻醉医生、体外循环医生及术后监护医生均相同；手术时均采用气管插管全身麻醉、低温去白细胞红细胞悬浮液及血浆预充、体外循环(CPB)管路，CPB结束后进行改良超滤，常规使用抗生素，以利于减少炎症反应。两组的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。
1.2方法
超快通道组给予患儿气管内插管，给予50 mg罗库溴铵注射液、0.2 mg芬太尼、3～5 mg咪达唑仑进行麻醉，气管内插管，吸入50%氧/空气、1%七氟烷进行麻醉维持，并输注10～400 mg/h的丙泊酚，若患儿有躁动现象发生，可给予肌松药治疗。复温后逐渐减浅麻醉至缝合，术后及早拔管。拔管指征：体温>36℃，肾功能尿量>0.5 ml/(kg·h)，出血量为胸腔引流，持续2 h的引流量<100 ml；动脉血氧分压 (PaO2)>80 mmHg；pH值>7.3，吸气负压>1.96 kPa，肺活量>10 ml/kg。 (谭小莉)
[关键词]超快通道手术；体外循环；室间隔缺损；经济效益
[中图分类号] R725.4 [文献标识码] A [文章编号] 1674-4721(2016)09(b)-0080-03
.Methods 53 children with ventricular septal defect underwent ultra fast channel ventricular septal defect repair in our hospital from May to July in 2015 in our hospital were selected as the super fast track group，65 children with ventricular septal defect underwent traditional repair of ventricular septal defect in our hospital from May to July in 2014 in our hospital were selected as the traditional operation group.The length of stay，the cost of hospitalization，the utilization rate of the bed and the residence time of the monitoring room in the two groups was compared，the economic benefit of ultra fast track surgery in the repair of ventricular septal defect was evaluated.Results The length of stay，the residence time of the monitoring room in the super fast track group was shorter than that in the traditional operation group，the cost of hospitalization in the super fast track group was less than that in the traditional operation group，the utilization rate of the bed in the super fast track group was shorter than that in the traditional operation group，with significant difference (P<0.01 or P<0.05).Conclusion The economic benefits of ultra fast track surgery in the treatment of pediatric ventricular septal defect is better than that the traditional operation method.
[Key words]Ultra fast track surgery；Extracorporeal circulation；Ventricular septal defect；Economic benefit
室间隔缺损属于小儿常见的一种先天性心脏病，在全部先天性心脏病发生率中占20%[1]。超快通道麻醉技术主要是指选择恰当的麻醉药物及方法，在快速通道上使患儿术毕即刻进行气管拔管或在术后1 h内进行拔管，以缩短患儿的机械通气时间及在监护室停留时间，在有效减少患者住院费用的同时，也有利于患儿的恢复[2]。本研究主要分析小儿室间隔缺损超快通道手术的经济效益，现报道如下。
1资料与方法
1.1一般资料
选取2015年5～7月在我院行超快通道室缺修补术的53例室间隔缺损患儿作为超快通道组，其中男33例，女20例；年龄43 d～5岁，平均(2.85±0.58)岁；体重6.3～18.0 kg，平均(10.85±1.47)kg。选取2014年5～7月在我院行传统室间隔缺损修补术的65例室间隔缺损患儿作为传统手术组，其中男41例，女24例；年龄53 d～6岁，平均(2.91±0.57)岁；体重8.8～16.0 kg，平均(10.87±1.43)kg。术前所有患儿均无呼吸道感染，无其他脏器并发症，无严重肺动脉高压；手术组医生、麻醉医生、体外循环医生及术后监护医生均相同；手术时均采用气管插管全身麻醉、低温去白细胞红细胞悬浮液及血浆预充、体外循环(CPB)管路，CPB结束后进行改良超滤，常规使用抗生素，以利于减少炎症反应。两组的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。
1.2方法
超快通道组给予患儿气管内插管，给予50 mg罗库溴铵注射液、0.2 mg芬太尼、3～5 mg咪达唑仑进行麻醉，气管内插管，吸入50%氧/空气、1%七氟烷进行麻醉维持，并输注10～400 mg/h的丙泊酚，若患儿有躁动现象发生，可给予肌松药治疗。复温后逐渐减浅麻醉至缝合，术后及早拔管。拔管指征：体温>36℃，肾功能尿量>0.5 ml/(kg·h)，出血量为胸腔引流，持续2 h的引流量<100 ml；动脉血氧分压 (PaO2)>80 mmHg；pH值>7.3，吸气负压>1.96 kPa，肺活量>10 ml/kg。 (谭小莉)