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目的探讨120-三甲医院CCU和120-二甲医院两种分流救治模式对不同程度急性心肌梗死患者治疗成本和效益的影响。方法由广州市“120”急救指挥中心提供资料,纳入2003年10月至2005年12月期间分流到广州市三甲医院进入CCU和分流到广州市二甲医院的急性心梗患者,分别按照梗死部位及严重并发症发生情况进一步分为单纯心梗组和复杂心梗组。在出院后半年进行随访,记录其住院总费用、住院期间死亡率,用SF-36量表量化其短期健康状况。以单因素方差分析及卡方检验比较两组间住院费用、死亡率、生活质量的差别。结果相对120-二甲医院模式,120-三甲医院CCU模式下单纯心梗组住院费用较高(P=0.016),住院死亡率无差别,社会功能、情感角色、心理健康、总体健康状况得分方面较高(P<0.05);复杂心梗组住院费用较高(P= 0.011),住院死亡率较低(P<0.01),躯体功能、一般健康状况、生命力、社会功能、情感角色、心理健康、总体健康状况得分方面较高(P<0.05)。结论120-三甲医院CCU模式能为梗死面积大、伴有严重并发症的复杂AMI患者提供更好的治疗效率。分流救治模式的选择对该类患者生存和短期预后的作用不容忽视。
Objective To investigate the effects of two diversion models of CCU and 120-II hospitals in 120- A hospitals on the treatment costs and benefits of patients with acute myocardial infarction of different degrees. Methods The data were provided by Guangzhou “120 ” Emergency Command Center and included in the cases of acute myocardial infarction who were diverted to the top three hospitals of Guangzhou City and shunted to the Second Hospital of Guangzhou City from October 2003 to December 2005, The incidence of infarction and serious complications were further divided into simple myocardial infarction group and complex myocardial infarction group. Six months after discharge, follow-up was performed to record the total cost of hospitalization and in-hospital mortality, and to quantify their short-term health status with the SF-36 scale. One-way ANOVA and Chi-square test were used to compare the differences in hospitalization costs, mortality and quality of life between the two groups. Results Compared with the 120-A hospital model, the hospitalization cost was higher in the 120-TCHA CCU group (P = 0.016), no difference in in-hospital mortality rate, social function, emotional role, mental health, and overall health status scores (P <0.05). The hospitalization cost was higher in the complicated MI group (P = 0.011), and the in-hospital mortality rate was lower (P <0.01). The physical function, general health status, vitality, social function, emotional role, mental health , Higher overall health status scores (P <0.05). Conclusion The CCU model of 120-AAA hospitals can provide better curative effect for complicated AMI patients with large infarction area and severe complications. The impact of the diversion treatment model on the survival and short-term prognosis of these patients should not be overlooked.