目的 分析不同地区先天性室间隔缺损患儿的住院资料,为制定相关临床策略和医保政策提供数据参考。方法 采用描述性研究方法,收集整理并分析892例于2009年1月1日-2012年12月31日在湖南省湘雅医院就诊的先天性室间隔缺损患儿临床特征。结果 892例患者中,男童495例,女童397例;诊断年龄>3岁的466例,≤3岁426例,年龄范围为0~14岁;城镇儿童为145例,农村747例;大病医保政策实施前就诊的患儿232例,实施后就诊660例;主要诊断为室间隔缺损且无合并症的患儿416例,有一种合并症的337例,两种或以上合并症的139例;有术后并发症的患儿119例,无并发症者773例;治疗有效888例,无效4例。不同地区患儿性别、年龄和术后并发症的分布差异均无统计学意义(χ²=0.686,0.002,1.544,P值均>0.05);城区患儿病情相对复杂(χ²=9.719,P=0.010)且治愈率低于农村患儿(χ²=6.312,P=0.012),大病医保实施后,农村患儿明显增多(χ²=12.788,P<0.001),且就诊人数逐年增多,与城区患儿差异有统计学意义(χ²=10.874,P=0.012)。结论 城区先天性室间隔缺损患儿病情相对危重,应在临床上予以重视。农村地区患儿受益于大病医保政策,积极诊疗的人数逐年增多。

Objective To analyze the clinical features of children with congenital ventricular septal defect in different area for providing a reference to make a medical insurance policy and clinical treatment strategies. Method A cluster sample of 892 children in Hunan province with ventricular septal defect diagnosed from January 1,2009 to December 31,2012 in Xiangya Hospital were collected and analyzed by descriptive research method. Results Of the 892 cases,495 cases were boys,while 397 cases were girls; 466 cases' diagnostic age were above 3 years old,while 426 cases were 3 years old or less,the range was 0 to 14 years old; 145 cases were came from urban,while rural children were 747 cases;232 cases were diagnosed before the implementation of serious illness medical insurance,while 660 cases were diagnosed after that;416 cases were ventricular septal defect without any complications,337 cases with one complications,and 139 cases with two or above two complications;119 cases with postoperative complications,while 773 cases without complications; 888 cases were cured,while 4 cases were dead.There was no statistical significance in gender,age,and postoperative complications (χ²=0.686,0.002,1.544,all P>0.05); And urban children condition was relatively complex (χ²=9.719,P=0.010)and the cure rate was lower than rural children (χ²=6.312,P=0.012);Rural children had increased quantity significantly after the implementation of serious illness insurance (χ²=12.788,P<0.001) and there was a significantly difference between urban and rural children with congenital ventricular septal defect (χ²=10.874,P=0.012). Conclusion Rural areas children with congenital ventricular septal defect get more benefits from the serious health policy and the number of clinical increased year by year,but due to the complex of condition of urban children,they have a lower cure rate.