换血治疗不同程度急性胆红素脑病患儿的成本-效果分析.DOCVIP

换血疗法治疗急性胆红素脑病的成本效益分析 李慧繁，何华云，刘开珍，华子瑜［通信作者］ ［通信作者］华子瑜，E-mail: ziyu_h@ （重庆医科大学附属儿童医院 新生儿诊治中心，重庆 400014 ） 摘要：目的 比较换血疗法（ET）治疗不同程度急性胆红素脑病（ABE）的成本效益，为ABE干预方案的选择提供参考。方法 回顾性分析2009年1月～2010年12月本中心137例ABE患儿的临床资料。结果 SE组（轻度ABE换血组）40例、SNE组（轻度ABE非换血组）29例、ME组（中重度ABE换血组）49例和MNE组(中重度ABE非换血组)19例。轻度ABE中，SE组TSB、TSB与血浆白蛋白的比值（B/A）、新生儿溶血病比例和人均住院费用均明显高于SNE组（P＜0.05），无死亡发生，不良预后发生率15.0%与SNE组13.8%相似；最大效益成本比分别为87.5和121.5。中重度ABE中，ME组TSB、B/A、新生儿溶血病比例和人均住院费用均显著高于MNE组（P＜0.05）；5例死亡，死亡-不良预后发生率32.7%，为MNE组15.8%的2.1倍；最大效益成本比分别为89.8和160.0。ME组TSB、B/A高于SE组（P＜0.05），死亡-不良预后发生率为SE组的2.2倍，换血疗法相关严重不良反应发生率12.2%为SE组5.0%的2.4倍，人均住院费用与SE组相似（P＞0.05）。结论 换血疗法对于轻度ABE的成本效益较好，可作为抢救治疗的首选；中重度ABE尤其是重度ABE需权衡利弊。新生儿病理性黄疸尽早光疗，避免或减轻ABE，降低死亡-不良预后发生率，减少资源消耗和经济损失。 关键词：新生儿；急性胆红素脑病；换血疗法；成本效益分析 Cost-benefit analysis of exchange transfusion for acute bilirubin encephalopathy LI Huifan, HE Huayun, LIU Kaizhen, HUA Ziyu（Department of Neonatology, Childrens Hospital of Chongqing Medical University, Chongqing 400014, China） ［Abstract］ Objective To assess the cost-benefit of exchange transfusion（ET) in the treatment of different severity of acute bilirubin encephalopathy(ABE). Methods Retrospective analysis was carried out on the clinical data of 137 ABE neonates admitted our department from January 2009 to December 2010. Results The enrolled neonates were divided into four groups by ABE severity and interventions: 40 neonates in Group SE (Subtle ABE with ET), 29 in Group SNE (Subtle ABE without ET), 49 in Group ME (Moderate to advanced ABE with ET), and 19 in Group MNE (Moderate to advanced ABE without ET). The Total Serum Bilirubin (TSB) levels, tSb:Albumin molar ratio(B/A), the proportion of blood group incompatibility and the hospitalization costs per capita in Group SE were obviously higher than those in Group SNE (P0.05). Without death in subtle ABE, the rate of poor outcomes in Group SE, 15.0% was similar to that of Group SNE, 13.8%. The maximum benefit-cost ratio of Group SE and Group SNE was 87.5