胃癌术后患者的不同营养治疗费用比较及其影响因素分析

目的:了解肠外营养(Parenteral Nutrition,PN)与肠内营养(Enteral Nutrition,EN)治疗临床应用和费用的现状及费用影响因素。方法:通过对87份胃癌手术患者的病例回顾性调查(PN EN 28份和PN59份),利用SPSS10．0进行临床疗效和费用的单因素比较,以及影响住院总费用的多因素分析。结果:2004年全部胃癌手术病例的营养治疗率为100％(单纯PN治疗率为69％,EN加PN的治疗率为31．0％);两组临床疗效无明显差异,但两组出院和入院自身状况比较,PN EN组略优于PN组;从住院日和各类人均费用指标来看,PN EN组明显高于PN组(有统计学差异);但其人日均EN药费为113．81元,明显低于本组或PN组的人日均PN药费(P=0．034);PN EN组和PN组病例进行了多因素分析,结果提示PN EN组和PN组影响住院总费用的首位因素均是PN药费。结论:胃癌患者术后EN的治疗率不足30％,多数适合EN治疗的患者并没有进行EN治疗;并且无论PN还是有限的EN治疗,均存在着相当程度的不规范治疗。目前影响临床营养合理用药的主要原因并不是医疗技术水平因素,更多的是非医疗技术水平以外的因素。要推动营养治疗的健康发展,单单依靠临床技术的教育和培养是远远不够的,如何制定合乎营养治疗实际情况的经济激励及医保支付和报销政策,以及实施临床营养治疗的监管措施,对于实现临床营养治疗的真正意义来说是至关重要的。

Comparative Study of Expenses on Different Nutrition Treatments on the Patients with Gastric Cancer Surgery and Analysis of the Factors Influencing the Expenses

Objective: To study the clinical application of PN and EN, and analyze the expenditure of the clinical application and factors. Methods: Retrospective investigation on the 87 cases of patients after surgery on gastric cancer PN EN(28); PN (59)]; univariate comparative analysis of curative effects and expense and multivariate analysis of the factors influencing the expenditure on hospitalization by using SPSS 10.0; Results: Nutritional cure rate of all gastric cancer surgeries in 2004 was 100% (PN only accounted for 69%, while PN plus EN 31.0%). No obvious difference was found out between the clinical curative effects of the two groups. But after compared the physical situations before and after hospitalization, the PN EN group seemed to be slightly better than the PN group. Seen from the hospitalized days and each indicators on individual expenditure, the numbers collected from the PN EN group were apparently higher than PN group (statistic variation), while the daily individual expense on EN medicament of the PN EN group was clearly lower than that on PN medicament of the same group or of the PN group (P=0.034). Multivarite analysis had been conducted on PN EN group and PN group. The results showed that the primary factor influencing the total expenditure on hospitalization was costs of PN medicament. Conclusion: The EN treatment rate of patients with gastric cancer surgery was less than 30%, and many patients who should take the EN treatment but didn't do so. What's more, below-the-mark PN and limited EN treatment widely existed. At present, the key factor influencing the rational clinical application of nutrition is not the low medical professionalism, but the non-professional factors. In order to promote the sound development of nutrition treatment, it's not enough to promote education and trainings on clinical techniques, and how to make policies encouraging economic incentive and policies of reimbursement and how to implement the regulations on clinical nutrition treatment are key to the realization of the clinical nutrition treatment.