超声造影引导注射治疗腹部实质脏器创伤的疗效与效益分析

目的 探讨超声造影(CEUS)引导局部注射治疗腹部实质脏器创伤的疗效,分析其成本效益.方法 CEUS引导局部注射治疗腹部实质脏器创伤患者112例127个脏器,其中肝破裂42个,脾破裂52个,肾挫裂伤33个.与手术治疗组比较,评价CEUS引导局部注射治疗效果,并分析其成本效益.结果 CEUS引导局部注射治疗组单脏器一次治疗时间20～30 min;治疗后72 h内血压、心率较治疗前明显改善(P＜0.05),与手术组差异无统计学意义(P＞0.05);注射治疗后即刻超声检查显示腹腔内游离液体无增加,之后超声随访显示腹腔游离液体逐渐减少并消失.CEUS引导局部注射治疗组住院天数3～11(5.4±2.4)d,与手术治疗组住院天数3～9(5.1±1.9)d比较差异无统计学意义(P＞0.05).在治疗费用方面,CEUS引导局部注射治疗组为0.32～0.43(0.36±0.14)万元,手术治疗组为3.1～4.2(3.6±10.8)万元,前者显著低于后者(P＜0.01).结论 CEUS引导局部注射治疗严重肝、脾、肾创伤的效果与手术治疗一致,但治疗费用显著低于后者;其优势尚在于免除开腹手术之苦,减少或避免输血,多数情况下可保留创伤脏器,患者恢复快,因此具有更人性化的特点.

Abstract：

Objective To analyse the cost-effectiveness analysis of the focal injection treatment under the guidance of contrast enhanced ultrasound(CEUS) for the severe abdominal parenchymal organs trauma.Methods One hundred and twelve patients with severe abdominal parenchymal organs trauma,including 42 hepatic injuries,52 splenic injuries and 33 renal injuries,were rolled in this study. The cost-effectiveness of this group was compared with that of surgery group. Results Treatment duration of single organ trauma under the guidance of CEUS was 20 - 30 minutes. During the first 72 hours after the focal injection, blood pressure and heart rate were improved ( P ＜0.05). Free intraperitoneal liquid did not increase on immediate US image of post-therapy and then it disappeared gradually. Heart rate returned to normal level after injection treatment ( P ＜0. 001 ). Lengths of stay in hospital was 3 - 11 (5.4 ± 2.4)days, which was not different with 3 - 9(5.1± 1.9) of surgery group( P ＞0.05). Treatment cost was 0.32 - 0.43 (0.36 ±0. 14) ten thousand RMB, which was obviously less than 3. 1 - 4. 2 (3.6 ± 10.8) ten thousand RMB of surgery group ( P ＜ 0.01 ). Conclusions The efficacy of the focal injection treatment of the severe abdominal parenchymal organs trauma under the guidance of CEUS was consistent with that of the operative treatment, but its cost was less. Especially it benefited for reserving organs and less pain.

Cost-effectiveness analysis of the focal injection treatment of the severe abdominal parenchymal organs trauma

Objective To analyse the cost-effectiveness analysis of the focal injection treatment under the guidance of contrast enhanced ultrasound(CEUS) for the severe abdominal parenchymal organs trauma.Methods One hundred and twelve patients with severe abdominal parenchymal organs trauma,including 42 hepatic injuries,52 splenic injuries and 33 renal injuries,were rolled in this study. The cost-effectiveness of this group was compared with that of surgery group. Results Treatment duration of single organ trauma under the guidance of CEUS was 20 - 30 minutes. During the first 72 hours after the focal injection, blood pressure and heart rate were improved ( P ＜0.05). Free intraperitoneal liquid did not increase on immediate US image of post-therapy and then it disappeared gradually. Heart rate returned to normal level after injection treatment ( P ＜0. 001 ). Lengths of stay in hospital was 3 - 11 (5.4 ± 2.4)days, which was not different with 3 - 9(5.1± 1.9) of surgery group( P ＞0.05). Treatment cost was 0.32 - 0.43 (0.36 ±0. 14) ten thousand RMB, which was obviously less than 3. 1 - 4. 2 (3.6 ± 10.8) ten thousand RMB of surgery group ( P ＜ 0.01 ). Conclusions The efficacy of the focal injection treatment of the severe abdominal parenchymal organs trauma under the guidance of CEUS was consistent with that of the operative treatment, but its cost was less. Especially it benefited for reserving organs and less pain.