發(fā)布時間：2018-05-28 05:04

  本文選題：重型肝炎 + 肝衰竭��； 參考：《天津大學》2014年碩士論文

【摘要】：研究目的：本研究通過選用一般情況調(diào)查表、SF-36醫(yī)學簡明量表、社會支持評定量表、自評抑郁量表和成本收集表，了解重型肝炎患者生命質(zhì)量現(xiàn)狀、影響因素和保守治療的成本-效用情況，為重型肝炎患者生命質(zhì)量的干預(yù)和治療的選擇提供依據(jù)。 研究方法：①通過文獻研究法，了解和把握當今國內(nèi)外重型肝炎患者生命質(zhì)量及藥物經(jīng)濟學的研究現(xiàn)狀和最新的研究進展。②在文獻研究的基礎(chǔ)上，選用一般情況調(diào)查表和SF-36醫(yī)學簡明量表、社會支持評定量表、自評抑郁量表對2012年1月到2013年8月期間在上海市四所三級醫(yī)院住院的312例重型肝炎患者進行生命質(zhì)量調(diào)查和影響因素的分析。③通過SF-36醫(yī)學簡明量表及自行編制的成本收集表對2012年3月到2013年6月上海市四所三級醫(yī)院被診斷為重型肝炎的出院患者284例進行調(diào)查，計算患者的總成本、總效用及成本-效用比情況。 研究結(jié)果：①本研究通過對重型肝炎患者生命質(zhì)量的數(shù)據(jù)分析顯示，其生命質(zhì)量得分低于正常人，與常模比較有統(tǒng)計學意義(p＜0.05)，提示重型肝炎患者的生活質(zhì)量較差。②通過單因素分析研究對象社會人口學信息對PCS、MCS得分的影響，結(jié)果發(fā)現(xiàn)年齡、有無保險、保險類型、并發(fā)癥的數(shù)量、疾病分型等對兩者總分的影響有統(tǒng)計學意義(p＜0.05)，是否抗病毒治療僅對PCS總分的影響有統(tǒng)計學意義(p＜0.05)；而性別、月收入、居住地等對兩者的影響均無統(tǒng)計學意義。③逐步多元線性回歸分析顯示年齡、并發(fā)癥數(shù)量是影響PCS得分的主要影響因素(p＜0.05)，，且與其呈負相關(guān)；并發(fā)癥數(shù)量以及有無保險是影響MCS得分的主要影響因素(p＜0.05)，且與其呈負相關(guān)。相關(guān)性分析結(jié)果顯示，重型肝炎患者的社會支持水平與PCS、MCS得分呈正相關(guān)，抑郁水平與PCS、MCS得分呈負相關(guān)。④通過對重型肝炎患者成本及效用的計算，結(jié)果顯示：重型肝炎患者的總成本為（42806.67±3896.45）元，總效用為1.33，成本-效用比為元32185.47元/QALYs。 研究結(jié)論：重型肝炎患者的生命質(zhì)量與正常人群相比較為低下，我們應(yīng)該積極對該人群的生命質(zhì)量實施干預(yù)，在干預(yù)的過程中要考慮年齡、有無保險、并發(fā)癥數(shù)量、社會支持等因素對患者造成的影響，開展有針對性的干預(yù)方案；另外，重型肝炎保守治療的成本較高，尤其是藥物的費用，需衛(wèi)生政府部門予以積極的關(guān)注和合理的調(diào)配。
[Abstract]:Objective: to investigate the quality of life of patients with severe hepatitis by selecting SF-36 medical brief scale, social support rating scale, self-rating depression scale and cost collection table. The influencing factors and the cost-effectiveness of conservative treatment provide basis for the intervention of quality of life and the choice of treatment in patients with severe hepatitis. Research methods: 1 through literature research, we understand and grasp the current research situation of quality of life and pharmacoeconomics of patients with severe hepatitis both at home and abroad and the latest research progress .2 on the basis of literature research, General situation questionnaire and SF-36 Medical brief scale, Social support rating scale, Investigation of quality of Life and influencing factors of 312 patients with severe Hepatitis hospitalized in four Grade III Hospitals in Shanghai from January 2012 to August 2013 From March 2012 to June 2013, 284 discharged patients diagnosed as severe hepatitis in four tertiary hospitals in Shanghai were investigated. Calculate the patient's total cost, total utility and cost-utility ratio. Results: 1 in this study, the quality of life score of patients with severe hepatitis was lower than that of normal people, according to the analysis of data on the quality of life of patients with severe hepatitis. Compared with the norm, there was significant difference (p < 0.05), which suggested that the quality of life of the patients with severe hepatitis was poor. 2 the effect of social demographic information on the MCS score of the patients with severe hepatitis was studied by univariate analysis. The results showed that age, insurance and type of insurance were found. The number of complications and the type of disease had significant effects on the total score of the two groups (p < 0.05). Whether the effect of antiviral therapy only on the total score of PCS was statistically significant (P < 0.05), but gender, monthly income, No stepwise linear regression analysis showed that the effect of residence and other factors on both was not statistically significant. The number of complications was the main influencing factor of PCS score (p < 0.05), and was negatively correlated with it. The number of complications and the availability of insurance were the main influencing factors of MCS score (P < 0.05), and were negatively correlated with them. The results of correlation analysis showed that the level of social support in patients with severe hepatitis was positively correlated with the score of MCS in patients with severe hepatitis, and the level of depression was negatively correlated with the score of MCS of patients with severe hepatitis by calculating the cost and effectiveness of the patients with severe hepatitis. The results showed that the total cost of severe hepatitis patients was 42806.67 鹵3896.45 yuan, the total utility was 1.33, and the cost-utility ratio was 32185.47 yuan / QALYS. Conclusion: the quality of life of the patients with severe hepatitis is lower than that of the normal population. We should actively intervene in the quality of life of this group. In the process of intervention, we should consider age, insurance or not, and the number of complications. In addition, the cost of conservative treatment of severe hepatitis is high, especially the cost of drugs, which needs the active attention and reasonable allocation of health departments.
【學位授予單位】：天津大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R575.1

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