3种中枢神经营养药物治疗新生儿缺氧缺血性脑病临床疗效的对比研究及卫生经济学评价  

Three Kinds of Central Neurotrophic Agents for Neonatal Hypoxic-ischemic Encephalopathy:a Comparative Study of Clinical Effect and Health Economic Benefits

作　　者：万静[1] 游勇[1] 陈晓燕 牛小玲 WAN Jing;YOU Yong;CHEN Xiaoyan;NIU Xiaoling(Department of Neonatology,Huangshi Central Hospital of Edong Medical Group(the Affiliated Hospital of Hubei Polytechnic University),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)新生儿科

出　　处：《实用心脑肺血管病杂志》2019年第7期79-82,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的比较脑苷肌肽、脑蛋白水解物及鼠神经生长因子治疗新生儿缺氧缺血性脑病(HIE)的临床疗效并进行卫生经济学评价。方法选取2016年2月-2019年2月鄂东医疗集团黄石市中心医院新生儿科收治的新生儿HIE患儿156例,采用随机数字表法分为A组、B组、C组,每组52例。在对症支持治疗基础上,A组患儿采用脑苷肌肽注射液治疗,B组患儿采用脑蛋白水解物注射液治疗,C组患儿采用注射用鼠神经生长因子治疗;三组患儿均连续治疗14 d。比较三组患儿临床疗效,治疗前后血清神经元特异性烯醇化酶(NSE)及S100β蛋白水平,治疗前及治疗7、10、14 d新生儿神经行为测定(NBNA)评分,治疗期间不良反应发生情况;采用成本-效果分析评价药物经济学效益,包括成本-效果比(C/E)和增量成本-效果比(ΔC/ΔE)。结果(1)三组患儿临床疗效比较,差异无统计学意义(P>0.05)。(2)三组患儿治疗前后血清NSE、S100β蛋白水平比较,差异无统计学意义(P>0.05);三组患儿治疗后血清NSE、S100β蛋白水平低于治疗前(P<0.05)。(3)时间与方法在NBNA评分上不存在交互作用(P>0.05);时间在NBNA评分上主效应显著(P<0.05);方法在NBNA评分上主效应不显著(P>0.05)。三组患儿治疗7、10、14 d NBNA评分高于治疗前(P<0.05)。(4)三组患儿治疗期间均未出现明显药物不良反应。(5)A组患儿C/E为12.76元,B组患儿为6.47元,C组患儿为29.76元;以B组为对照,A组患儿每增加1个单位效果需增加成本154.51元,C组患儿每增加1个单位效果需增加成本1 079.31元。按照药品销售价格上下浮动15%进行一维敏感性分析,结果显示,以B组为对照,A组患儿每增加1个单位效果分别需增加成本177.69元和131.33元,C组患儿每增加1个单位效果分别需增加成本1 241.21元和917.42元。结论脑苷肌肽、脑蛋白水解物及鼠神经生长因子治疗新生儿HIE的短期临床疗效相似,均能有效改善患儿神经系统功能Objective To compare the clinical effect and health economic benefits of Cattle Encephalon Glycoside and Ignotin Injection(CEGI),Cerebroprotein Hydrolysate Injection(CHI)and Mouse Nerve Growth Factor(mNGF)in treating neonatal hypoxic-ischemic encephalopathy(HIE).Methods A total of 156 neonates with HIE were recruited from Huangshi Central Hospital of Edong Medical Group from February 2016 to February 2019,and the were divided into groups A,B and C according to random number table method,with 52 cases in each group.Based on symptomatic supportive treatment,neonates in groups A,B and C received CEGI,CHI and mNGF,respectively;all of the three groups continuously treated for14 days.Comparisons were made in the three groups in terms of clinical effect,pre-and post-treatment serum levels of NSE and S100β protein,NBNA score before treatment,at the 7 th,10 th and 14 th days of treatment,and incidence of adverse drug reactions during treatment;cost-effectiveness analysis was performed to estimate pharmacoeconomic benefits,including cost-effectiveness ratio(C/E)and incremental cost-effectiveness ratio(ΔC/ΔE).Results(1)There was no statistically significant difference in clinical effect in the three groups(P>0.05).(2)There was no statistically significant difference in serum level of NSE or S100 β protein in the three groups before or after treatment(P>0.05);after treatment,serum levels of NSE and S100β protein were statistically significantly lower in the three groups compared with those before treatment(P<0.05).(3)There was no statistically significant interaction between time and method in NBNA score(P>0.05);main effect of time was statistically significant in NBNA score(P<0.05),but main effect of method was not(P>0.05).NBNA score at the 7 th,10 th and 14 th days of treatment was statistically significantly higher than baseline in the three groups(P<0.05).(4)No one occurred any obvious adverse drug reactions during treatment in the three groups.(5)C/E in groups A,B and C was 12.76,6.47 and 29.76 yuan,respectively.ta

关 键 词：缺氧缺血性脑病 新生儿 脑苷肌肽 脑蛋白水解物 鼠神经生长因子 疗效比较研究 药物经济学 

分 类 号：R743[医药卫生—神经病学与精神病学]