Mortality and economics in short bowel syndrome
Mortality and economics in short bowel syndrome
复制标题
DOI：
10.1016/s1521-6918(03)00079-9
复制
发表时间：
2003-12-01
影响因子：
3.2
通讯作者：
Höllwarth, ME
中科院分区：
文献类型：
--
作者：
Schalamon, J;Mayr, JM;Höllwarth, ME
近年来，由于重症监护医学和肠外营养技术的进步，短肠综合征（SBS）患者的发病率有所增加。这些技术显著改善了失去肠道主要部分的新生儿、儿童和成人的预后。长期生存是可能的，并且主要不取决于剩余肠的长度，而是取决于并发症，如肠外营养相关的胆汁淤积，复发性败血症，中心静脉导管感染和剩余肠的运动。因此，SBS婴儿的总体相关死亡率范围为15 - 25%，成人为15 - 47%，这取决于患者的年龄、基础疾病和全肠外营养的持续时间。家庭肠外营养（HPN）显著降低了并发症的发生率，改善了患者的心理状况。此外，HPN显著降低了住院费用。然而，每名病人每年的费用在10万至15万美元之间。SBS患者在HPN治疗5年后的死亡率约为30%，仍低于小肠移植的5年生存率，与小肠移植后患者的生存率大致相当。然而，与长期HPN计划的成本相比，2年后成功的肠移植的总成本已经较低。
The incidence of patients with short-bowel syndrome (SBS) has increased over the years due to progress of intensive care medicine and parenteral nutrition techniques. These techniques have significantly improved the prognosis of neonates, children and adults who have lost major parts of their intestinal tract. Long-term survival is possible and does not depend primarily on the length of the remaining bowel but on complications such as parenteral nutrition-associated cholestasis, recurrent septicaemia, central venous catheter infections, and the motility of the remaining intestine. Thus, the overall related mortality in infants with SBS ranges from 15 to 25%, and in adults from 15 to 47%, depending on the age of the patients, the underlying disease, and the duration on total parenteral nutrition. Home parenteral nutrition (HPN) significantly decreases the complication rate and improves the psychological situation of the patient. Additionally, HPN reduces in-hospital cost significantly. Nevertheless, the annual costs/patient are between $100000 and $150000. The mortality rate of SBS patients on HPN is about 30% after 5 years, which is still lower than the 5-year survival rate of intestinal grafts, and it is about equal to patients' survival after intestinal transplantation. However, the overall costs of a successful intestinal transplantation are already lower after 2 years when compared with the cost of a prolonged HPN programme.