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在一个发展中国家,先天性心脏手术的改善:危地马拉的经验
Luis A Larrazabal1, Kathy J Jenkins, Kimberlee Gauvreau
1Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Circulation
|October 30, 2007
概括
美国儿科心脏手术实践被传播到危地马拉,显著降低了先天性心脏手术风险调整后的死亡率. 这表明了风险调整后死亡率测量的价值,用于评估发展中国家的计划改进.
科学领域:
- 全球健康 全球健康
- 儿科心脏手术 儿科心脏手术
- 卫生健康发展计划发展计划
背景情况:
- 1997年在危地马拉启动了一项全面的儿科心脏手术计划,利用美国的专业知识.
- 专注于改善外科手术结果和减少住院死亡率.
- 需要在发展中国家的背景下评估计划的有效性.
研究的目的:
- 评估危地马拉儿童心脏手术计划的改善情况.
- 量化随着时间的推移,风险调整后在医院死亡率的减少.
- 将结果与美国基准进行比较.
主要方法:
- 对1215例儿科心脏外科手术 (1997-2004) 的回顾性队列研究.
- 数据分为三个时间段,并与2000年儿童住院患者数据库进行比较.
- 用先天性心脏手术风险调整 (RACHS-1) 方法评估风险调整后的死亡率.
主要成果:
- 总体死亡率为10.7%.
- 该RACHS-1方法显示强烈的歧视 (AUC=0.854).
- 风险调整后的死亡率随着时间的推移显著下降,与美国基准相比,标准化死亡率从10.0降至5.7.
结论:
- 危地马拉在短时间内实现了先天性心脏手术死亡率的大幅降低.
- 风险调整的死亡率测量是评估儿科心脏病计划进展的有效工具.
- 强调了在资源有限的环境中先进的外科实践的成功转移和适应.
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