本文關(guān)鍵詞： 百萬貧困白內(nèi)障患者復(fù)明工程 術(shù)后效果 并發(fā)癥 成本/效果　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過分析享受政府“百萬貧困白內(nèi)障患者復(fù)明工程”資助的貧困白內(nèi)障患者手術(shù)效果及其相關(guān)影響因素,為提高適宜有效、方便可及、費(fèi)用低廉、可持續(xù)的貧困白內(nèi)障手術(shù)效率提供依據(jù)。方法:運(yùn)用回顧性分析方法,采用內(nèi)容包括:基本信息、術(shù)前視力、白內(nèi)障類型、核硬度、相關(guān)全身疾病、眼部其他疾病、視力差(年)、術(shù)中并發(fā)癥、手術(shù)方式、術(shù)后早期并發(fā)癥、術(shù)后3d視力、費(fèi)用等信息的白內(nèi)障臨床效果調(diào)查表,隨機(jī)抽取2012年4月至2012年2月在山西省眼科醫(yī)院受“百萬貧困白內(nèi)障復(fù)明工程”資助行白內(nèi)障手術(shù)治療的貧困組205例205眼、非貧困組226例226眼進(jìn)行術(shù)后效果、成本/效果的比較分析。所收集數(shù)據(jù)經(jīng)過復(fù)核無誤后,采用多重回歸模型進(jìn)行術(shù)后視力影響因素分析。手術(shù)醫(yī)師、護(hù)理標(biāo)準(zhǔn)無區(qū)別,所有信息采集及信息錄入由同一位具有一定專業(yè)知識人員完成。結(jié)果:1.貧困組和非貧困組術(shù)前術(shù)后視力比較:⑴貧困組與非貧困組術(shù)前視力比較差異有統(tǒng)計學(xué)意義(P0.001),貧困組術(shù)前視力平均值低于非貧困組;⑵貧困組與非貧困組術(shù)后3d視力比較差異有統(tǒng)計學(xué)意義(P0.001),且兩組較術(shù)前視力提高程度之間差異有統(tǒng)計學(xué)意義(P0.001),非貧困組較貧困組視力提高更為明顯,手術(shù)效果好;⑶貧困組與非貧困組術(shù)前視力與術(shù)后3d視力比較差異均具有統(tǒng)計學(xué)意義(P0.001),兩組患者手術(shù)后視力均明顯提高;⑷貧困組術(shù)后脫盲率為94.1%,脫殘率為76.6%;非貧困組術(shù)后脫盲率為98.7%,脫殘率為89.4%,達(dá)到國家扶貧白內(nèi)障手術(shù)相關(guān)標(biāo)準(zhǔn)要求。2.貧困組與非貧困組術(shù)中術(shù)后并發(fā)癥比較:⑴貧困組術(shù)中并發(fā)癥有后囊膜破裂、玻璃體丟失、晶狀體核沉入玻璃體1例及懸韌帶斷裂1例,非貧困組未見術(shù)中并發(fā)癥發(fā)生,兩組術(shù)中并發(fā)癥發(fā)生率無明顯差異(P0.05);⑵貧困組術(shù)后38例有角膜水腫、2例有高眼壓表現(xiàn),非貧困組術(shù)后角膜水腫9例、黃斑水腫2例,兩組術(shù)后并發(fā)癥發(fā)生率差異具有統(tǒng)計學(xué)意義(P0.001),貧困組術(shù)后早期并發(fā)癥發(fā)生率高于非貧困組。3.貧困組與非貧困組術(shù)后視力影響因素分析:⑴貧困組術(shù)后3d視力影響因素有視力差(年)、白內(nèi)障分類、核硬度及眼部其他疾病(P0.05),而年齡、性別對術(shù)后視力無明顯影響(P0.05);⑵非貧困組術(shù)后3d視力主要影響因素有白內(nèi)障分類及眼部其他疾病(P0.05),年齡、性別及核硬度對術(shù)后視力無明顯影響;⑶綜合組術(shù)后3d視力影響因素主要有白內(nèi)障分類、核硬度及眼部其他疾病(P0.05),年齡、性別對術(shù)后視力無明顯影響。4.貧困組與非貧困組多重回歸模型對術(shù)后視力影響因素進(jìn)行分析:⑴眼部其他疾病、核硬度是貧困組術(shù)后視力的影響因素,回歸方程為Y=3.817-0.384X1+0.159 X2;⑵眼部其他疾病是非貧困組術(shù)后視力的影響因素,回歸方程為Y=2.793+0.15 X。5.貧困組手術(shù)成本及成本/效果分析:⑴貧困組患者總費(fèi)用為(2098.707±353.478)元,非貧困組(5077.190±1753.448)元,差異具有統(tǒng)計學(xué)意義(P0.001);⑵貧困組治愈的成本/效果為3284.362元,低于非貧困組治愈成本/效果6154.170元;⑶貧困組白內(nèi)障患者手術(shù)脫盲的成本/效果為2220.854元,低于非貧困組白內(nèi)障患者手術(shù)成本/效果5144.063元;⑷貧困組白內(nèi)障患者手術(shù)脫殘的成本/效果為2739.826元,低于非貧困白內(nèi)障患者脫殘手術(shù)成本/效果5679.183元。結(jié)論:1.白內(nèi)障分類、眼部其他疾病、核硬度是貧困組影響術(shù)后視力的主要因素;2.貧困組手術(shù)費(fèi)用低于非貧困組,且貧困組手術(shù)成本/效果較非貧困組低。3.貧困組術(shù)后視力較術(shù)前視力明顯提高,效果確切。脫盲率為94.1%,脫殘率為76.6%,達(dá)到國家相關(guān)對貧困患者復(fù)明手術(shù)的相關(guān)要求,“百萬貧困白內(nèi)障患者復(fù)明工程”是費(fèi)用低廉、效果確切的白內(nèi)障扶貧復(fù)明策略之一。
[Abstract]:Objective: to analyze the factors of poor cataract patients enjoy the operation effect of the government "millions of poor cataract patients and its related project, in order to improve the appropriate and effective, convenient and low cost, provide the basis for cataract surgery in poor efficiency and sustainable. Methods: using a retrospective analysis method, the contents include: basic information, preoperative visual acuity, type of cataract, nuclear hardness, systemic disease and other diseases of the eye, poor eyesight (years), intraoperative complications, surgical methods, postoperative complications, postoperative visual acuity was 3D, the clinical effect of cataract cost information, randomly selected from April 2012 to February 2012 by the millions of poor cataract treatment project the poor cataract surgery group 205 cases 205 eyes in Eye Hospital of Shanxi Province, the non poverty group 226 cases 226 eyes underwent the effect, comparative analysis of cost / effect. The data collected through review and correct analysis, using multiple regression model for postoperative visual acuity factors. The surgeon, the standard of care without distinction, all the information collection and information input by the same one has completed certain professional knowledge workers. Results: 1. compared with the poor group and the non poor eyesight group before and after surgery are: 1 the statistical significance of the poor group and the non poor preoperative visual acuity difference (P0.001), poverty group preoperative visual acuity less than the average non poverty group; the poverty group was statistically significant and non poor postoperative visual acuity difference 3D (P0.001), and the difference was statistically significant between the two groups was better than preoperative vision degree (P0.001), non impoverished group than in poor eyesight improved more obviously, the operation effect is good; the poverty group and non poverty group preoperative visual acuity and postoperative visual acuity of 3D were statistically significant (P0.001), visual acuity of two groups of patients after surgery Increased; the poverty group after the literacy rate is 94.1%, and the residual rate was 76.6%; the non poverty group after the literacy rate is 98.7%, and the residual rate was 89.4%, reached the standard of national poverty related cataract surgery.2. poverty group and non poverty group complications in comparison: the complication group was poor a posterior capsular rupture, vitreous body loss, 1 cases of lens nucleus into vitreous body and suspensory ligament rupture in 1 cases, non impoverished group had no complications during operation, complications of the two groups were no significant difference in the incidence of poverty (P0.05); the group of 38 patients with corneal edema, 2 cases with high intraocular pressure, the non poverty group the postoperative corneal edema in 9 cases, 2 cases of macular edema, postoperative complications of the two groups was statistically significant difference in the incidence of poverty group (P0.001), early postoperative complication rate was higher than that of non impoverished group.3. poverty group and non poverty factors influencing the eyesight after the operation of group analysis: the poverty group The influence factors of the 3D visual acuity after poor eyesight (years), nuclear cataract classification, hardness and other ocular diseases (P0.05), and age, gender has no significant effect on postoperative visual acuity (P0.05); the main influence factors of 3D non vision poverty group after cataract and other ocular disease classification (P0.05), age gender, and nuclear hardness had no obvious effect on postoperative visual acuity; the factors of 3D visual effect of comprehensive group are mainly Cataract Classification, nuclear hardness and other ocular diseases (P0.05), age, sex on the postoperative visual acuity had no significant effect on the.4. group and the non poverty poverty group multiple regression model of factors affecting postoperative visual acuity analysis: the other eye disease, nuclear hardness is visual impact factors of poverty group, the regression equation was Y=3.817-0.384X1+0.159 X2; the other is the eye disease factors influence non poor eyesight after the operation of group, the regression equation was Y=2.793+0.15 X.5. poverty groups Analysis of the effect of operation cost and total cost: 1 / poor patients was (2098.707 + 353.478), non poverty group (5077.190 + 1753.448), the difference was statistically significant (P0.001); the effect of poor cure cost is 3284.362 yuan, lower than the non poor groups into the cure effect of 6154.170 yuan /; the effect of the poor group of patients with cataract surgery have the cost of 2220.854 yuan, lower than the non poor groups of patients with cataract surgery cost / effect 5144.063 yuan; the poor group of patients undergoing cataract removal of residual cost is 2739.826 yuan, lower than the non poor cataract patients for removing residual operation cost / effect 5679.183 yuan. Conclusion: 1. Cataract Classification and other diseases of the eye, nuclear hardness is the poor group main factors affecting postoperative visual acuity; 2. poor group operation cost is lower than the non poor group and poor group operation cost / effect than the non impoverished group low.3. poverty group after operation visual acuity The visual acuity was improved, the effect is obvious. The literacy rate is 94.1%, and the residual rate was 76.6%, to meet the relevant requirements of the relevant national poverty patients with cataract surgery, "millions of poor cataract patients is one of the engineering cost is low, the exact effect of cataract cataract poverty alleviation strategy.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.66

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