肝硬化食道靜脈曲張出血病人經結紮盛行率、 醫療資源耗用及死亡率之探討

研究目的歷年來肝硬化或慢性肝病，是整體死因的第五到第八名，國人每年因肝癌及肝硬化結束生命者超過一萬人。肝硬化及其所引發的食道靜脈曲張出血等相關疾病，對國人生命健康造成威脅。本研究目的探討肝硬化食道靜脈曲張出血病人經結紮盛行率、醫療資源耗用、死亡率的分析。研究方法一、本研究採用國家衛生研究院全民健康保險資料庫（National Health Insurance Research Database，NHRB），進行回朔性（Retrospective）次級資料的縱貫研究（Longitudinal Study）分析，針對肝硬化食道靜脈曲張出血接受結紮治療（ICD-9-CM處置碼分別為456.0及456.2）之病患為研究對象，研究期間為1996年至2010年共15年，樣本數共151,863人。二、採用SPSS Version 19.0 for Windows（SPSS Inc，IL）統計套裝軟體執行統計分析，分為描述性統計(以平均值與標準差及次數分配和百分比)與推論性統計(卡方檢定、one-way ANOVA檢定與複迴歸分析、Cox存活分析)。研究結果一、在1996年至2010年，肝硬化合併食道靜脈曲張出血病患盛行率隨時間逐年減少的趨勢。二、將此肝硬化合併食道靜脈曲張出血病患以每5年分T1(1996-2000)、T2(2001-2005)、T3(2006-2010)三個時期，T1組為新台幣61,219元、T2組為新台幣68,991元、T3組為新台幣82,089元，呈現逐年增加的趨勢。三、肝硬化合併食道靜脈曲張出血病患三時期，住院天數T1組10.2天、T2組9.6天、T3組9.7天，呈現下降再上升趨勢。四、病患住院期間死亡率16.9%、一年內死亡率48.7%、三年內死亡率72.1%、五年內死亡率84.4%。結論與建議本研究為國內首次針對肝硬化合併食道靜脈曲張出血病患長期研究（1996-2010），提供盛行率、總醫療費用及死亡率趨勢之探討，研究發現國人在盛行率及住院天數等已有顯著下降，此趨勢與國外主要國家之研究相似，顯示國內醫療技術的進步，然而如何控制逐年高漲的健保費用是衛生當局一重要議題。

關鍵字

盛行率；醫療資源耗用；死亡率；肝硬化；食道靜脈曲張出血

並列摘要

Objectives: Cirrhosis or chronic liver disease over the years, the overall cause of death in the fifth to eighth place, people end their lives more than ten thousand people each year from liver cancer and cirrhosis. Cirrhosis and its related diseases such as esophageal variceal bleeding are a life-health threat for people. The purpose of this study was to explore the prevalence, medical resource utilization, and mortality in cirrhotic esophageal varices bleeding patients after ligation. Methods: ?P Data were collected from the NHRB（National Health Insurance Research Database）from the years 1996 to 2010 for 151,863 patients with cirrhotic esophageal varices bleeding with a retrospective longitudinal study, the specific ICD-9-CM codes utilized were 456.0 and 456.20. ?P The SPSS Version 19.0 for Windows (SPSS Inc., IL) was employed to conduct descriptive statistics (mean and standard deviation and frequency distribution and percentage) and inferential statistics (chi-square test, one-way ANOVA test and multiple regression analysis, the Cox survival analysis). Results: ?P The prevalence rate of cirrhotic esophageal varices bleeding patients with ligation decreasing from 1996 to 2010. ?P The medical resources trends of cirrhotic esophageal varices bleding patients with ligation increasing about 15% from T1 to T3 (T1: NT$61,219; T2: NT$69,991; T3:NT$82,089.5). ?P The length of stay in hospital (LOS) decreasing from 10.2 in T1 to 9.6 in T2 and increasing to 9.7 in T3. ?P The average mortality in hospital is 16.9%, and one-year following mortality is 48.7%, three-year following mortality is 72.1% and five-year following mortality is 84.4%. Conclusion: This is the first study to analyze nationwide trends of prevalence, total costs, and mortality related to oesophageal variceal hemorrhage in TAIWAN. Our study found that the prevalence rate and hospitalization days has been a significant decline in this trend with major foreign countries, and also shows the progress of the medical treatment. But the health care and insurance costs rising year after year and how to control those problems will become a very important issue for government.