不停跳冠狀動脈繞道手術醫療資源耗用與臨床結果分析

An Comparative Analysis of Medical Resource use and Clinical Outcome of Beating Heart Coronary Artery Bypass Surgery

謝雅萍(Ya-Ping Hsieh)

指導教授 ： 林文德

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2010年)

https://doi.org/10.6833/CJCU.2010.00078

摘要

背景：針對冠狀動脈繞道手術CABG(使用體外循環或是不停跳的方式仍未有定論，陸續有隨機控制試驗與回朔性的研究文章發表，反觀國內卻少有相關之研究，加上國人得到冠狀動脈疾病也有逐年遞增傾向。利用台灣健保資料庫，使用回朔性式，比較這兩種術式醫療資源耗用與短期的臨床醫療結果。
方法：根據國家衛生研究院全民健保資料庫取自2005年1月1日至2008年11月30日止，施行冠狀動脈繞道手術者共有588位，使用不停跳手術者有位體外循環者有位，分析影響使用CPB或OPCAG因子，包括年齡、性別、糖尿病、洗腎病患等共有11項，並使用多變項邏輯式回歸，控制每個變項，再分析使用兩種術式其術後ICU天數、呼吸器使用天數與住院總天數以及死亡率(出院後30天有無門診追蹤)與術後有無洗腎情形。
結果：使用CPB與OPCAB在住院總天數（19.3105 vs 16.420）與ICU停留天數(6.8463 vs 4.9463；P＜0.05)，兩者在統計有顯著意義。呼吸器使用天數(2.149 vs 1.979；p＜0.670)無統計上顯著差異，在費用的耗用健保費用（489682 vs 443832；p<0.0001）與醫院費用(433990 vs 334272；p<0.0001)有顯著差異。醫療結果面CPB與OPCAB死亡率(13.47% vs 7.33% ；p=0.0452) 與術後造成洗腎(2.74% vs 2.0%；p=0.6199)，並無顯著差異。
結論:針對施行冠狀動脈繞道手術，使用不停跳手術的方式可降低住院總天數與住加護病房天數及醫療費用的花費；死亡率與術後造成洗腎兩者在使用CPB或OPCAB並沒差異性。
Key words:CPB: cardiopulmonary bypass (體外循環冠狀動脈繞道手術) OPCAB:off-pump coronary artery bypass(不停跳冠狀動脈繞道手術) ICU:intensive care unit(加護病房)

關鍵字

體外循環冠狀動脈繞道手術 ； 不停跳冠狀動脈繞道手術 ； 加護病房

並列摘要

Background — Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years. The best approach myocardial revascularization remains controversial. Comparative analysis of medical resource use and clinical outcome of beating heart coronary bypass surgery by using a longitudinal health insurance database 2005(LHIID2005) of the national health insurance research database(NHIRD).
Methods and Results — From January 2005 to November 2008, 588 patients received isolated myocardial revascularization in Taiwan. Among them , 150 underwent OPCAB(off-pump group), and 438 cardiopulmonary bypass(CPB)(on-pump group). We analyzed eleven preoperative variables, including the preoperative underline diseases. Multivariable logistic regression was used to identify independent predicators of outcomes. OPCAB and CPB patients had similar demographics. The in-hospitals mortality of (13.47% vs 7.33% ；P=0.0452) and postoperative dialysis((2.74% vs 2.0%；p=0.6199) found no significant different between CPB and OPCAB. However, OPCAB had shorter hospital stays (16.4 vs 19.3 days ；P<0.05) and lower ICU stays (6.8 vs 4.9 days；P<0.05). Furthermore, the hospital costs of the OPCAB group was significantly lower than that of CPB group(433990 vs 334272；p<0.0001)
Conclusions —OPCAB does not produce lower postoperative mortality or postoperative of dialysis rate than CPB. However, it can reduced length of hospital stay and cost of hospitalization.
Key words: ■CPB: cardiopulmonary bypass ■OPCAB: off-pump coronary artery bypass ■ICU: intensive care unit

並列關鍵字

CPB: cardiopulmonary bypass ； OPCAB: off-pump coronary artery bypass ； ICU: intensive care unit

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