临终医疗的卫生技术评估系列研究Ⅰ.围脑死亡期医疗服务的现状及费用分析

目的　了解我国围脑死亡期医疗服务现状 ,分析其治疗效果和费用特点。　方法　采用回顾性系列病例研究方法 ,对 1 999年 6月～ 2 0 0 0年 1 2月、2 0 0 1年 1 1月～ 2 0 0 2年 6月间四川大学华西医院外科ICU 940例患者的治疗情况和部分直接医疗成本进行调查分析 ,数据统计与分析使用SPSS 1 0 .0软件。　结果　以病人出现深昏迷、瞳孔对光反射消失和无自主呼吸中的任二种 ,且持续时间超过 1h为围脑死亡期的纳入标准 ,共纳入病例 1 1 5例 ,死亡率高达 99.1 0 % ,人均医疗费 2 5 1 5 .9元 /天。影响费用的主要因素是院内感染 (P =0 .0 0 7)和围脑死亡期持续时间 (P <0 .0 5 )。且随着围脑死亡期持续时间延长 ,患者死亡率迅速增加 ,80 %的病人在符合纳入标准后 72h内死亡。　结论　国内围脑死亡期医疗服务仍主要采用全力抢救模式 ,资源浪费严重。应积极促进脑死亡立法 ,呼吁理性的临终医疗。

Health Technology Assessment of End-of-Life Care Ⅰ.The Present Status and Cost Analysis of Health Care in Peri-brain-death

Objectives To investigate present status of health care in peri-brain-death and analyze its effectiveness and health economic characteristics. Method Retrospective analysis of case series was conducted and a total of 940 patients from surgical intensive care unit (SICU) were reviewed on treatment and part of direct medical expenditure. The patients admitted from Jun. 1999 to Dec. 2000 and Nov. 2001 to Jun. 2002 were included in this study. Data were processed by SPSS 10.0. Result Patients were included if they had two of the three symptoms for at least one hour: deep coma, pupillar light reflex disappear, and no autonomic respiratory. Ultimately 115 patients were included, with a total cost of $2 515.9 per day for each case, whereas mortality was 99.10%. Mortality increased with the state of peri-brain-death prolonged. Eighty percent of patients included were dead within 72 hours after admission. Conclusion Attempts to resuscitate patients of peri-brain-death have been the most widely applied in China, however, it resulted in great unnecessary consumption of health resources. It is of great importance to promote legislation of brain death in China.