頭頸部神經鞘瘤患者醫療使用情形之效益評估

Assessment on Medical Utilization of Head and Neck Schwannomas Patients

陳柏秀(Po-Hsiu Chen)

指導教授 ： 陳淑賢

中臺科技大學/管理學院/健康產業管理研究所/碩士(2012年)

摘要

神經鞘瘤以頭頸部患者居多，此類患者術後容易有神經損傷的情形，導致神經鞘瘤患者比良性腫瘤病患消耗更多醫療資源。因此本研究目的在於分析頭頸部神經鞘瘤患者於術後神經損傷及復發的情形，並推算患者的醫療費用，以利進行效益評估。
本研究資料來源為西元2003年1月至2010年12月期間，共收集69位曾罹患頭頸部神經鞘瘤患者作回溯性資料分析。統計方法為列聯相關、卡方檢定、單因子變異數、獨立樣本t檢定來分析。
結果顯示女性罹患人數多於男性，平均發病年齡為47.84歲。腫瘤以小於兩公分佔大多數，最常出現的部位是顏面神經與聽神經。此外，腫瘤部位對腫瘤大小、術前壓迫神經症狀皆有顯著關聯性。腫瘤部位、術前壓迫神經症狀、治療方式對術後神經損傷有顯著的影響。
建議依神經鞘瘤病程來訂定照護標準作業流程，使患者、家屬和醫療人員能熟知照護知識和技巧，讓患者能有效治療，減少其身體和心理之傷害，並降低醫療資源的浪費。

關鍵字

頭頸部神經鞘瘤 ； 效益評估 ； 醫療使用 ； 神經損傷

並列摘要

Most schwannoma occurred in head and neck. Schwanmomas patients had nerve injury after operation. The aim of this study is to analyze the head and neck schwannomas patients that postoperative nerve injury and recurrence cost more medical fees. The medical costs for schwannomas care are growing to compare with the gradual of benign tumor. The study want to evaluate the medical expenses of the head and neck schwannomas patients that postoperative nerve injury, in order to facilitate the effectiveness assessment.
The resource of the data was collected from January 2003 to December 2010 in Taichung Veteran Hospital. The total sample size is 69 head and neck schwannoma patients. This study is a retrospective study. Statistical method contain contingency coefficient and chi-square test, one-way ANOVA and independent-sample t-test.
The results indicate female are more easy to have head and neck schwannomas than male with the mean age of diagnosis at 47.84 years. Most of head and neck schwannomas has less than 2cm tumor. The most common observation was found along the facial nerve and auditory nerve. Tumor size and preoperative nerve symptoms would associate with tumor location. Tumor location, preoperative nerve symptoms and treatment would significantly affect postoperative nerve injury.
The findings of this study suggest to establish the standard operating procedures of caring the schwannomas patients, so that patients and his family become familiar with medical staff in the care knowledge and skills. The schwannomas patients can be treated effectively to reduce the physical and psychological harm and reduce the waste of medical resources.

並列關鍵字

Nerve injury ； Head and neck schwannomas ； Assessment effectiveness ； Medical Utilization

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