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急性菌痢治疗方案的卫生经济学研究 |
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黄亚玲1 李建新2 向幼华1 曾 靖2
摘要 笔者通过应用氨基糖甙类及头孢三代类抗生素治疗急性细菌性痢疾的前瞻性临床研究，体外药物敏感试验的实验研究及药物治疗成本的统计学研究，发现两类抗生素的临床疗效及体外敏感率无差异(P>0.05)，而其治疗成本(用每天每公斤体重多少元人民币表示)却差异有显著性。三代头孢类平均治疗成本是氨基糖甙类的44.85倍，最大成本复达新是最小成本庆大霉素的364倍。采用成本最小分析法进行卫生经济学评价认为治疗菌痢不宜首选三代头孢类抗生素。
关键词 菌痢 卫生经济学 氨基糖甙类 头孢三代类
Study on the Cost-effectiveness of Therapeutic Scheme of Acute Bacillary Dysentery Huang Yaling*,Li Jianxin,Xiang Youhua,et al. * The First Clinical College,Tongji Medical University,Wuhan 430022
Abstract A prospective study on the costs of acute bacillary dysentery treatment with antibiotics of aminoglycoside and the 3rd generation of cephalosporin,along with drug sensitive test in vitro was carried out.The results showed that the clinical therapeutic effects and the sensitive rates to drug in vitro between the two kinds of antibiotics were not statistically different (P>0.05),but the costs of treatment with these two methods were significantly different.The therapeutic costs were calculated in Ren Ming Bi per day per kilogram body weight.The average therapeutic cost with the 3rd generation of cephalosporin was 44.85 times as that with aminoglycoside.The highest cost by Fortum was 364 times Higher than by Gentamycin.Through cost analysis,conclusion was drawn that the 3rd generation of cephalosporin should not be taken as first choice to treat a acute bacillary dysentery.
Key words Bacillary dysentery Hygienic economics Aminoglycoside The 3rd generation of cephalosporin
急性细菌性痢疾是小儿最常见的急性传染病之一，由于目前尚无疫苗及其他有效的预防措施，加之城市流动人口多，饮食卫生差等社会因素，其发病率居高不下，特别是夏、秋季节为其发病高峰。其病因明确，诊断简单，治疗有效，预后良好；但近年来抗生素的发展较快，各种新型抗生素、高级抗生素、进口抗生素不断进入临床应用，大大提高了治疗成本，造成了很大的卫生资源浪费，引起各界的关注。本研究通过对临床上最常用于治疗菌痢的两类不同类型抗生素的临床疗效观察及体外药敏试验的实验研究，评价其疗效差异，用统计研究其治疗成本差异，采用成本最小分析法进行卫生经济学评价，报道如下。
临床资料
一、研究对象：病人来自1996年6～10月间在武汉市协和医院儿科及武汉市儿童医院住院之急性菌痢患儿，共92人，其中男性53人，女性39人，男∶女=1.34∶1，年龄3～14岁。
二、标准：
1.纳入标准：①急性腹泻，脓血便；②大便常规：白细胞以上，有红细胞，吞噬细胞；③大便培养有志贺氏菌生长[1] [2] 下一页
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