地佐辛联合舒芬太尼对比舒芬太尼单独用于术后镇痛的经济学评价
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摘要
目的:评价地佐辛联合舒芬太尼(DS组)和单用舒芬太尼(S组)用于术后镇痛48 h内的经济性。方法:以医疗卫生系统为研究角度进行经济学评价,基于Meta分析结果,对不存在显著差异的结局指标进行最小成本分析,对存在显著差异的结局指标进行成本-效果分析。结果:地佐辛剂量为0. 2和0. 3 mg·kg-1时,DS组相比S组患者每降低10%VAS疼痛评分并维持1 h需多付出的成本为16. 63和19. 67元。地佐辛剂量为10 mg时,DS组和S组各时点VAS评分均不存在统计学显著差异,DS组的镇痛成本为283. 02元,S组成本为181. 81元,单用舒芬太尼镇痛更经济。在镇痛满意度方面,DS组"优秀率"和"良好率"均高于S组。敏感性分析与基础分析结果较一致。结论:地佐辛联合舒芬太尼对比舒芬太尼用于术后镇痛,在不存在显著差异的指标上,单用舒芬太尼更经济;在存在显著差异的指标上,地佐辛联合舒芬太尼效果好但成本也较高。由于无确定的阈值,地佐辛联合舒芬太尼用于术后镇痛是否经济需依赖于决策者的知识与主观判断。
Objective: To evaluate the economy of the combination of dezocine and sufentanil(DS)compared with sufentanil(S) for postoperative analgesia in 48 hours. Methods: Meta-analysis methods were used to conduct the economic evaluation in the perspective of medical and health system. Cost-minimization analysis was used when there were no significant differences in outcomes,and cost-effectives analysis was used when there were significant differences in outcomes according the result of Meta-analysis. Results: There were significant differences on VAS at each time point when the dezocine leave equals 0. 2 mg·kg-1. The incremental cost of DS to keep decreasing 10% of scores on VAS for 1 h compared with S was 16. 63 yuan. The incremental cost of DS to keep decreasing 10% of scores on visual analogue scale for 1 h compared with S was 19. 67 yuan when the dezocine leave equals 0. 3 mg·kg-1. There were no significant differences in scores on VAS at each time point when the dezocine leave equals 10 mg. The analgesic cost of DS and S were 283. 02 yuan and 181. 81 yuan respectively. It means that sufentanil alone was more economical. The analgesic satisfaction of patient,the"excellent rate"and"good rate"of DS were higher than S. There were no significant differences between the results of sensitivity analysis and primary analysis. Conclusion: According to the evaluation of the combination of dezocine and sufentanil compared with sufentanil alone for postoperative analgesia,sufentanil alone was more economical in the outcomes that there were no significant differences. The effectiveness of the combination of dezocine and sufentanil was better and the cost was higher compared with sufentanil alone in the outcomes that there were significant differences. It depended on the sense and subjective judgment of decision maker to assess the economy of the combination of dezocine and sufentanil compared with sufentanil alone for postoperative analgesia due to the lack of threshold.
Objective: To evaluate the economy of the combination of dezocine and sufentanil(DS)compared with sufentanil(S) for postoperative analgesia in 48 hours. Methods: Meta-analysis methods were used to conduct the economic evaluation in the perspective of medical and health system. Cost-minimization analysis was used when there were no significant differences in outcomes,and cost-effectives analysis was used when there were significant differences in outcomes according the result of Meta-analysis. Results: There were significant differences on VAS at each time point when the dezocine leave equals 0. 2 mg·kg-1. The incremental cost of DS to keep decreasing 10% of scores on VAS for 1 h compared with S was 16. 63 yuan. The incremental cost of DS to keep decreasing 10% of scores on visual analogue scale for 1 h compared with S was 19. 67 yuan when the dezocine leave equals 0. 3 mg·kg-1. There were no significant differences in scores on VAS at each time point when the dezocine leave equals 10 mg. The analgesic cost of DS and S were 283. 02 yuan and 181. 81 yuan respectively. It means that sufentanil alone was more economical. The analgesic satisfaction of patient,the"excellent rate"and"good rate"of DS were higher than S. There were no significant differences between the results of sensitivity analysis and primary analysis. Conclusion: According to the evaluation of the combination of dezocine and sufentanil compared with sufentanil alone for postoperative analgesia,sufentanil alone was more economical in the outcomes that there were no significant differences. The effectiveness of the combination of dezocine and sufentanil was better and the cost was higher compared with sufentanil alone in the outcomes that there were significant differences. It depended on the sense and subjective judgment of decision maker to assess the economy of the combination of dezocine and sufentanil compared with sufentanil alone for postoperative analgesia due to the lack of threshold.
引文
[1]曹淑娥,岳修勤,巩红岩.舒芬太尼复合地佐辛术后镇痛对二尖瓣置换患者免疫功能的影响[J].中国医师杂志,2011,13(3):416-418.
[2]冷希圣,韦军民,刘连新,等.普通外科围手术期疼痛处理专家共识[J].中华普通外科杂志,2015,30(2):166-173.
[3]罗剑萍.地佐辛联合舒芬太尼用于术后静脉自控镇痛的应用[J].医学信息(上旬刊),2011,24(10):6733-6734.
[4]王志勇.地佐辛对舒芬太尼诱发的全麻诱导期呛咳反应的抑制作用[J].世界最新医学信息文摘,2017,17(65):95.
[5]朱群芳,褚国强.舒芬太尼不同给药方式全麻诱导对手术患者呛咳反应的影响[J].中国继续医学教育,2017,9(20):65-68.
[6]方亮.地佐辛对舒芬太尼诱发的全麻诱导期呛咳反应的抑制作用[J].临床医药文献电子杂志,2016,3(27):5457,5460.
[7]邱建斌.地佐辛在全麻诱导期预防呛咳反应的体会[J].齐齐哈尔医学院学报,2016,37(7):888-889.
[8]孟镇镇,张林,王世端,等.地佐辛预防舒芬太尼诱发患者全麻诱导期呛咳反应的可行性研究[J].现代生物医学进展,2013,13(10):1911-1913.
[9]宗志军,王义桥.全麻诱导期舒芬太尼分两次外周静脉注射对其诱发呛咳反应的影响[J].安徽医药,2012,16(12):1849-1850.
[10]岳柏华,岳冬晗,李洪林.橼酸舒芬太尼不同注药速度诱发呛咳反应的临床观察[J].中国现代药物应用,2011,5(4):126-127.
[11]孙育红.控制给药速度预防舒芬太尼诱发的呛咳反应[J].护理研究,2009,23(16):1463-1465.
[12]倪欣,王凯,史东平,等.地佐辛联合其他药物用于术后镇痛的合理配伍[J].世界临床药物,2017,38(2):142-144.
[2]冷希圣,韦军民,刘连新,等.普通外科围手术期疼痛处理专家共识[J].中华普通外科杂志,2015,30(2):166-173.
[3]罗剑萍.地佐辛联合舒芬太尼用于术后静脉自控镇痛的应用[J].医学信息(上旬刊),2011,24(10):6733-6734.
[4]王志勇.地佐辛对舒芬太尼诱发的全麻诱导期呛咳反应的抑制作用[J].世界最新医学信息文摘,2017,17(65):95.
[5]朱群芳,褚国强.舒芬太尼不同给药方式全麻诱导对手术患者呛咳反应的影响[J].中国继续医学教育,2017,9(20):65-68.
[6]方亮.地佐辛对舒芬太尼诱发的全麻诱导期呛咳反应的抑制作用[J].临床医药文献电子杂志,2016,3(27):5457,5460.
[7]邱建斌.地佐辛在全麻诱导期预防呛咳反应的体会[J].齐齐哈尔医学院学报,2016,37(7):888-889.
[8]孟镇镇,张林,王世端,等.地佐辛预防舒芬太尼诱发患者全麻诱导期呛咳反应的可行性研究[J].现代生物医学进展,2013,13(10):1911-1913.
[9]宗志军,王义桥.全麻诱导期舒芬太尼分两次外周静脉注射对其诱发呛咳反应的影响[J].安徽医药,2012,16(12):1849-1850.
[10]岳柏华,岳冬晗,李洪林.橼酸舒芬太尼不同注药速度诱发呛咳反应的临床观察[J].中国现代药物应用,2011,5(4):126-127.
[11]孙育红.控制给药速度预防舒芬太尼诱发的呛咳反应[J].护理研究,2009,23(16):1463-1465.
[12]倪欣,王凯,史东平,等.地佐辛联合其他药物用于术后镇痛的合理配伍[J].世界临床药物,2017,38(2):142-144.