纳美芬与纳洛酮联合无创正压通气治疗慢性阻塞性肺疾病并Ⅱ型呼吸衰竭患者临床疗效的对比研究及卫生经济学评价  

Comparative Study for Clinical Effect and Hygienic Economic Evaluation in Treating COPD Patients Complicated with Type Ⅱ Respiratory Failure between Nalmefene and Naloxone Based on Non-invasive Positive Pressure Ventilation

作　　者：郭庆[1] 李静静 田青[1] 何伟[1] 柯正华[1] GUO Qing;LI Jingjing;TIAN Qing;HE Wei;KE Zhenghua(Department of Geriatrics,Huangshi Central Hospital of Edong Medical Group(the Affiliated Hospital of Hubei Institute ofTechnology),Huangshi 435000,China)

机构地区：[1]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)老年科,湖北省黄石市435000

出　　处：《实用心脑肺血管病杂志》2019年第3期71-74,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：黄石市医药卫生科研立项项目(2015-3-8)

摘　　要：目的比较纳美芬与纳洛酮联合无创正压通气治疗慢性阻塞性肺疾病(COPD)并Ⅱ型呼吸衰竭患者的临床疗效并进行卫生经济学评价。方法选取2015年1月—2018年10月鄂东医疗集团黄石市中心医院呼吸内科收治的COPD并Ⅱ型呼吸衰竭患者190例,采用随机数字表法分为纳洛酮组和纳美芬组,每组95例。在常规治疗基础上,纳洛酮组患者给予盐酸纳洛酮注射液联合无创正压通气治疗,纳美芬组患者给予盐酸纳美芬注射液联合无创正压通气治疗;两组患者均连续治疗7 d。比较两组患者临床疗效、治疗前后动脉血气分析指标〔包括pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及动脉血氧饱和度(SaO_2)〕及治疗期间药物相关不良反应发生情况;采用成本-效果分析两组患者经济学效益,包括成本-效果比(C/E)和增量成本-效果比(ΔC/ΔE)。结果 (1)纳美芬组患者临床疗效优于纳洛酮组(P<0.05)。(2)治疗前两组患者pH值、PaO_2、PaCO_2及SaO_2比较,差异无统计学意义(P>0.05);治疗后纳美芬组患者pH值、PaO_2、SaO_2高于纳洛酮组,PaCO_2低于纳洛酮组(P<0.05)。(3)两组患者治疗期间均未发生明显药物相关不良反应。(4)纳美芬组患者纳洛酮/纳美芬费用、直接治疗成本多于纳洛酮组,床位费少于纳洛酮组(P<0.05);两组患者其他药品费用、治疗费用、护理费用及检查费用比较,差异无统计学意义(P>0.05)。(5)纳洛酮组患者C/E为24.27,纳美芬组为25.13;以纳洛酮组为对照,纳美芬组患者每增加1个单位效果需增加成本30.20元。按直接治疗成本上下浮动10%进行一维敏感性分析,结果显示,以纳洛酮组为对照,纳美芬组患者每增加1个单位效果分别需增加成本27.18元和33.22元。结论纳美芬联合无创正压通气治疗COPD并Ⅱ型呼吸衰竭患者的临床疗效优于纳洛酮联合无创正压通气,二者用药安全性均较高,但纳洛酮较纳美芬更具Objective To compare the clinical effect and hygienic economic evaluation in treating COPD patients complicated with typeⅡrespiratory failure between nalmefene and naloxone based on non-invasive positive pressure ventilation.Methods A total of 190 COPD patients complicated with typeⅡrespiratory failure admitted to the Department of Respiratory Medicine in Huangshi Central Hospital of Edong Medical Group from January 2015 to October 2018 were randomly divided into Nalmefene group and Naloxone group,95 cases in each group.On the basis of routine treatment,patients in Naloxone group received naloxone hydrochloride injection combined with non-invasive positive pressure ventilation,while patients in Nalmefene group received namefen hydrochloride injection combined with non-invasive positive pressure ventilation;both groups continuously treated for 7 days.Clinical effect,arterial blood-gas analysis results(including pH value,PaO2,PaCO2 and SaO2)before and after treatment,and incidence of drug related adverse reactions were compared between the two groups;meanwhile economic analysis was performed by cost-effectiveness analysis,including cost-effectiveness ratio(C/E)and incremental cost-effectiveness ratio(ΔC/ΔE).Results(1)Clinical effect in Nalmefene group was statistically significantly better than that in Naloxone group(P<0.05).(2)There were no statistically significant difference in pH value,PaO2,PaCO2 or SaO2 between the two groups before treatment(P>0.05);after treatment,pH value,PaO2 and SaO2 in Nalmefene group were statistically significantly higher than those in Naloxone group,while PaCO2 was statistically significantly lower than that in Naloxone group(P<0.05)(.3)No one in the two groups occurred any obvious drug related adverse reactions during treatment(.4)Cost of Naloxone/Nalmefene,direct treatment fee in Nalmefene group were statistically significantly more than those in Naloxone group,while bed cost in Nalmefene group was statistically significantly less than that in Naloxone group(P<0.05);there was

关 键 词：慢性阻塞性肺疾病 呼吸功能不全 纳美芬 纳洛酮 治疗结果 药物经济学 

分 类 号：R563.9[医药卫生—呼吸系统]