台灣地區心血管治療的成長變化及其對以及復健的可能影響

The Growth of Interventional Cardiac Revasularization in Taiwan: Impact on Cardiac Rehabilitation

蔡美文(Tsai Mei-Wun) ； 季瑋珠(Chie Wei-Chu)

《物理治療》 29卷1期 (2004/02) Pp. 31-39

摘要

研究目的：在於了解經皮冠狀動脈擴張術(PTCA)及冠狀動脈繞道手術(CABG)在台彎地區的施行量及變化趨勢，以有助於展望及省思物理治療在心臟復健的參與重點。方法：截取健保抽樣資料檔之住院醫療費用清單明細檔（1996年至2001年）中PTCA或CABG相關治療的病例資料，及合併醫事機構基本資料檔。統計分析比較二種治療在六年間的施行量及成長趨勢、醫療費用、住院日及出院時死亡率的差異性。結果：PTCA與CABG的施行量在1996年至2001年均有逐年增加的趨勢，PTCA的施行量更是已超越CABG的數量（約為4倍），且在六年間有較多的成長量（分別為4.9倍與1.6倍之差）。而PTCA的平均總醫療費用、住院日及出院時的死亡率均明顯地低於CABG者，PTCA後有利用復健治療的比例(0.9~16.8%)相較於CABG(46.4~67.9%)明顯地偏低，二種心血管治療之復健費用均不高，只各佔其總醫療費用之1.0%。結論：台灣地區之PTCA在近幾年確有快速成長的趨勢，且施行量已超越了CABG，此與歐美多數國家的變化相類似，也是反映了在權衡醫療效益及精簡醫療費用的必然趨勢。而PTCA後參與復健治療率的偏低，可能受其住院日數縮減及健保給付制度的影響，在現今台彎地區之心臟復健仍多偏重住院期介入而較少出院後的規劃，加以有明顯區域資源分布不均的現象，很容易流失及輕忽了對這群病人的多元化完整照護，值得相關專業人員的省思。

關鍵字

經皮冠狀動脈擴張術 ； 冠狀動脈繞道手術 ； 醫療利用 ； 復健治療

並列摘要

Purposes: The aims of this study were to investigate the procedure and growth of interventional cardiac revascularization—percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft(CABG)in Taiwan, and to prospect its impact on cardiac rehabilitation. Methods: This study was based in part on the data from the National Health Insurance Research Database. According to ICD-9CM codes of PTCA and CABG, the related data were extracted from the files of Inpatient Expenditures by Admissions and Registry for Contracted Medical Facilities (1996 to 2001).We compared PTCA with CABG for the frequency of procedure, medical costs, duration of hospitalization, and mortality rate at discharge by years. Results: Both PTCA and CABG procedures were increasing in Taiwan. The procedures of PTCA were 2.0 to 4.5 times of the CABG in these six years (from 1996 to 2001). The growth of PTCA was also more rapid than CABG (494% versus 159%).The short-term medical utilization of CABG including total medical fee and duration of hospitalization were more expensive and longer than those of PTCA. And the mortality rate after CABG were also larger at discharge(3.1~5.5% vs 0.6~0.9%).Although the increasing procedures, there were only a few proportion of post-PTCA subjects (about 0.9~16.8%)to attend inpatient rehabilitation program. Uneven distribution of the rehabilitation ultilization was also found over the regions of Taiwan. Conclusions: The change in the overall practice of coronary revascularization may be an appropriate response to the combination of overwhelming evidence of clinical benefit and rapid technological advance. The increasing numbers and short duration of hospitalization for PTCA procedure relative to CABG, the focus in cardiac physiotherapy and rehabilitation had better change on risk factor intervention and outpatient program. The issue of regional distribution in cardiac rehabilitation should be also concerned in the future.

並列關鍵字

Percutaneous Transluminal Coronary Angioplasty ； Coronary Ar-tery Bypass Graft ； Medical ultilization ； Cardiac rehabilitation