膝关节镜术患者腰麻与喉罩全麻成本效益的分析与评价
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摘要
【目的】本研究拟用成本—效果分析的方法,将日间膝关节镜术患者的麻醉成本进行收集和测算,从而对腰麻及喉罩全麻两种麻醉方式做出成本效益学的分析和评价。
【方法】选择日间择期行关节镜下关节腔清理术、游离体摘除术、半月板修整/修补术或切除术的患者共30例,ASAⅠ～Ⅱ级、年龄18～65岁。患者被随机分为两组:腰麻组(SA组)和喉罩全麻组(GA组)。SA组以布比卡因9 mg于L_(3-4)间隙行蛛网膜下腔阻滞麻醉,喉罩组以七氟醚+喉罩行全身麻醉,分别记录术中麻醉占用时间及术后占用PACU的时间。分时点随访患者术后的心率、血压,切口疼痛情况,有无发生麻醉相关并发症,SA组下肢运动及排尿功能的恢复情况,并记录其麻醉满意度评价,直至患者符合日间手术病人出院标准离院。最后以患者该次手术的所有麻醉花费作为成本,以其完全符合日间手术出院标准离院作为效果,分别计算得各组的成本—效果比。再结合各组的术中麻醉占用时间(除手术时间外所有麻醉操作占用手术室的时间)、PACU滞留时间及术后恢复情况三方面作为辅助参考指标,对两组进行成本—效益学分析,从而比较得出更适用于日间关节镜术患者的麻醉方案。
【结果】两组间年龄、性别、ASA分级和手术种类无显著性差异。SA组较之GA组有较长的PACU滞留时间(SA:241±74 min,GA:37±15 min,P=0.00)和较低的围术期麻醉总费用(SA:726.6±3.1 RMB,GA:1683.2±61.5 RMB,P=0.00)。而GA组相比于SA组则有着更短的术中麻醉占用时间(SA:22.4±2.3 min,GA:12.3±1.9 min,P=0.00)和更好的麻醉满意度(P=0.009)。两组的术后疼痛评分无显著性差异,且均未发生麻醉失败或严重的麻醉不良反应,但SA组的术后麻醉并发症的发生率却显著高于GA组(SA:46.7%,GA:0%,P=0.006).。
【结论】对于日间膝关节镜术患者,以布比卡因行腰麻虽是一种经济有效的麻醉选择,但却有着较长的门诊留院时间及较多的麻醉不良反应。而以喉罩吸入全麻的麻醉方式虽然费用略高,但却可明显缩短患者的门诊留院时间,提高麻醉满意度。
Objectives:The purpose of this study is to compare the cost-effectiveness of spinal anaesthesia and general anaesthesia using LMA in ambulatory patients undergoing knee arthroscopy.
Methods:30 ASAⅠandⅡpatients,aged between 18-65 years old,scheduled for ambulatory knee arthroscopy were randomizedly divided into two groups.In the SA group,subarachnoid block was achieved with 9 mg bupivacaine,while the GA group received a general anaesthesia with LMA and sevoflurane.Postoperatively,both groups were monitored in PACU until they met the discharge standards of ambulatory patients undergoing spinal or general anaesthesia.Operating room turnover times of anaesthesia(exclusive of operation time),PACU recovery times,and patient satisfaction were recorded by an observer using an objective scale for recovery assessment and a verbal rating scale for satisfaction.Statistical analysis was performed with analysis of variance and X.We regarded all the economic cost of each anaesthesia as the cost,and the discharge of this patients as the effect,that we can work out a cost-effectiveness ratio of each group.At last we compared the cost-effectiveness ratios of the 2 groups,as well as the side-effect rates,the VAS pain scores and satisfaction degrees,to draw a conclusion that which kind of anaesthesia is better for the ambulatory knee arthroscopy patients.
Results:There were no significant differences between patients of Group SA and Group GA regarding age,sex,ASA grade and the kinds of knee arthroscopy surgeries. Group SA had a longer PACU recovery time(SA:241±74 min,GA:37±15 min,P =0.00)and a lower total anaesthesia cost(SA:726.6±3.1 RMB,GA:1683.2±61.5 RMB,P=0.00) than Group GA.While Group GA has a shorter room turnover time of anaesthesia(SA:22.4±2.3 min,GA:12.3±1.9 min,P=0.00) and a better patient satisfaction(P=0.009).VAS pain scores did not differ in both groups(P=0.489). There were no anesthetic failures or serious adverse events in either group.The anaesthesia-associated side-effect rates was more frequent in Group SA than in Group GA(SA:46.7%,GA:0%,P=0.006).
Conclusion:For ambulatory patients undergoing knee arthroscopy,spinal anesthesia with bupicaine is an cost-effective alternative,but is associated with a longer discharge time and increased side effects.While general analgesia with LMA can provide a shorter peri-operative time and a better patient satisfaction,but cost a little higher.
【方法】选择日间择期行关节镜下关节腔清理术、游离体摘除术、半月板修整/修补术或切除术的患者共30例,ASAⅠ～Ⅱ级、年龄18～65岁。患者被随机分为两组:腰麻组(SA组)和喉罩全麻组(GA组)。SA组以布比卡因9 mg于L_(3-4)间隙行蛛网膜下腔阻滞麻醉,喉罩组以七氟醚+喉罩行全身麻醉,分别记录术中麻醉占用时间及术后占用PACU的时间。分时点随访患者术后的心率、血压,切口疼痛情况,有无发生麻醉相关并发症,SA组下肢运动及排尿功能的恢复情况,并记录其麻醉满意度评价,直至患者符合日间手术病人出院标准离院。最后以患者该次手术的所有麻醉花费作为成本,以其完全符合日间手术出院标准离院作为效果,分别计算得各组的成本—效果比。再结合各组的术中麻醉占用时间(除手术时间外所有麻醉操作占用手术室的时间)、PACU滞留时间及术后恢复情况三方面作为辅助参考指标,对两组进行成本—效益学分析,从而比较得出更适用于日间关节镜术患者的麻醉方案。
【结果】两组间年龄、性别、ASA分级和手术种类无显著性差异。SA组较之GA组有较长的PACU滞留时间(SA:241±74 min,GA:37±15 min,P=0.00)和较低的围术期麻醉总费用(SA:726.6±3.1 RMB,GA:1683.2±61.5 RMB,P=0.00)。而GA组相比于SA组则有着更短的术中麻醉占用时间(SA:22.4±2.3 min,GA:12.3±1.9 min,P=0.00)和更好的麻醉满意度(P=0.009)。两组的术后疼痛评分无显著性差异,且均未发生麻醉失败或严重的麻醉不良反应,但SA组的术后麻醉并发症的发生率却显著高于GA组(SA:46.7%,GA:0%,P=0.006).。
【结论】对于日间膝关节镜术患者,以布比卡因行腰麻虽是一种经济有效的麻醉选择,但却有着较长的门诊留院时间及较多的麻醉不良反应。而以喉罩吸入全麻的麻醉方式虽然费用略高,但却可明显缩短患者的门诊留院时间,提高麻醉满意度。
Objectives:The purpose of this study is to compare the cost-effectiveness of spinal anaesthesia and general anaesthesia using LMA in ambulatory patients undergoing knee arthroscopy.
Methods:30 ASAⅠandⅡpatients,aged between 18-65 years old,scheduled for ambulatory knee arthroscopy were randomizedly divided into two groups.In the SA group,subarachnoid block was achieved with 9 mg bupivacaine,while the GA group received a general anaesthesia with LMA and sevoflurane.Postoperatively,both groups were monitored in PACU until they met the discharge standards of ambulatory patients undergoing spinal or general anaesthesia.Operating room turnover times of anaesthesia(exclusive of operation time),PACU recovery times,and patient satisfaction were recorded by an observer using an objective scale for recovery assessment and a verbal rating scale for satisfaction.Statistical analysis was performed with analysis of variance and X.We regarded all the economic cost of each anaesthesia as the cost,and the discharge of this patients as the effect,that we can work out a cost-effectiveness ratio of each group.At last we compared the cost-effectiveness ratios of the 2 groups,as well as the side-effect rates,the VAS pain scores and satisfaction degrees,to draw a conclusion that which kind of anaesthesia is better for the ambulatory knee arthroscopy patients.
Results:There were no significant differences between patients of Group SA and Group GA regarding age,sex,ASA grade and the kinds of knee arthroscopy surgeries. Group SA had a longer PACU recovery time(SA:241±74 min,GA:37±15 min,P =0.00)and a lower total anaesthesia cost(SA:726.6±3.1 RMB,GA:1683.2±61.5 RMB,P=0.00) than Group GA.While Group GA has a shorter room turnover time of anaesthesia(SA:22.4±2.3 min,GA:12.3±1.9 min,P=0.00) and a better patient satisfaction(P=0.009).VAS pain scores did not differ in both groups(P=0.489). There were no anesthetic failures or serious adverse events in either group.The anaesthesia-associated side-effect rates was more frequent in Group SA than in Group GA(SA:46.7%,GA:0%,P=0.006).
Conclusion:For ambulatory patients undergoing knee arthroscopy,spinal anesthesia with bupicaine is an cost-effective alternative,but is associated with a longer discharge time and increased side effects.While general analgesia with LMA can provide a shorter peri-operative time and a better patient satisfaction,but cost a little higher.
引文
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[2]胡善联.卫生经济学[M].上海:复旦大学出版社,2003.315-316.
[3]Joshi GP.Balanced anesthesia with Ⅳ propofol induction and inhalation anesthesia with N20 for maintenance,and an LMA for airway management.Anesthesiol Clin North America.2003 Jun;21(2):263-72.
[4]Demeere JL,Merckx Ch,Demeere N.Cost minimisation and cost effectiveness in anaesthesia for total hip replacement surgery.A study comparing three general anaesthesia techniques.Acta Anaesthesiol Belg.2006;57(2):145-51.
[5]Michael F.Mulroy,MD,Kathleen L.Larkin,MD,Peter S.Hodgson,MD,James D.Helman,MD,Julia E.Pollock,MD,and Spencer S.Liu,MD.A Comparison of Spinal,Epidural,and General Anesthesia for Outpatient Knee Arthroscopy.Anesth Analg2000;91:860-4.
[6]Martikainen M,Kangas-Saarela T,L(o|¨)pp(o|¨)nen A,Ohtonen P,Salom(a|¨)ki T.Two percent lidocaine spinal anaesthesia compared with sevoflurane anaesthesia in ambulatory knee surgery-cost-effectiveness,home readiness and recovery profiles.Ambul Surg.2001 Jul;9(2):77-81.
[7]Luttropp HH,Orlanders K,Ikonomidou E.Spinal,sevoflurane,or propofol anesthesia for outpatient knee arthroscopy.Anesthesiology 1998;89:A41.
[8]Edward T.Riley,Sheila E.Cohen,Alex Macario,Jayshree B.Desai,and Emily F.Ratner.Spinal Versus Epidural Anesthesia for Cesarean Section:A Comparison of Time Efficiency,Costs,Charges,and Complications.Anesth Analg 1995;80:709-12 709-712.
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