老年患者胸腔镜术后镇痛方案的风险与成本效果分析  

Analysis of the risk and cost-effectiveness of analgesia after thoracoscopic surgery in elderly patients

作　　者：江永贤 褚燕琦[1] 李根 沈江华[1] 张兰[1] 邢晓璇[1] JIANG Yongxian;CHU Yanqi;LI Gen;SHEN Jianghua;ZHANG Lan;XING Xiaoxuan(Department of Pharmacy,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Pharmacy,Chengdu Women's and Children's Central Hospital,Chengdu 611731,Sichuan Province,China)

机构地区：[1]首都医科大学宣武医院药学部,北京100053 [2]成都市妇女儿童中心医院药学部,成都611731

出　　处：《世界临床药物》2021年第5期412-418,共7页World Clinical Drug

基　　金：北京市医院管理中心“登峰”计划专项(DFL20190803)。

摘　　要：目的通过对两种不同镇痛方案用于胸腔镜术后的开展情况和成本效应分析,对临床药师的药学服务和干预提供参考。方法选择2020年1月至10月在首都医科大学宣武医院以行全身麻醉胸腔镜(部分)肺叶切除的术后老年患者,根据纳排标准,纳入140例患者,根据是否使用镇痛泵分成2组:镇痛泵组114例,非镇痛泵组26例。收集患者基本情况、镇痛药物评分、镇痛环节及途径、镇痛药物使用、不良反应以及相关费用进行风险分析,并利用成本效果分析对两种不同方案进行经济学评价。结果在两组的镇痛评分中,镇痛泵组术后1 d的平均评分为2.88分,高于非镇痛泵组的2.07分,差异有统计学意义(P<0.05),镇痛泵组48 h疼痛显著缓解率为87.72%,非镇痛泵组显著缓解率为80.76%,差异无统计学意义(P>0.05)。非镇痛泵组使用曲马多的比例较高,且有14例(53.84%)未使用阿片类药物,可有效节约阿片类的用量。非镇痛泵组中帕瑞昔布平均使用天数为6.34 d,高于镇痛泵组的5.46 d;帕瑞昔布超剂量例数比例50.00%,高于镇痛泵组的26.31%;非甾体药物联用例数比53.84%,低于镇痛泵组的85.08%,差异均有统计学意义(P<0.05)。48 h成本效果评估中,镇痛泵组获得1%单位的镇痛效果需花费21.97元,高于非镇痛泵组的13.50元,敏感性分析中镇痛泵组高于非镇痛泵组。结论我院此类患者由于术后多环节镇痛,导致患者多种非甾体药物联用,超剂量和超时间的使用,导致较大的风险和患者镇痛成本的增加。此次调查为医院下一步可以建立此类患者镇痛药物使用标准和临床路径,以及临床药师开展药学服务和干预提供参考。Objective To provide reference for clinical pharmacists’ pharmaceutical care and intervention by analyzing the development and cost-effect of two different analgesia schemes after thoracoscopy.Methods A total of 140 elderly patients who underwent thoracoscopic (partial) lobectomy under general anesthesia in Xuanwu Hospital of Capital Medical University from January to October 2020 were enrolled according to the admission criteria.They were divided into two groups according to whether an analgesic pump was used or not,which are analgesic pump group (n=114) and non-analgesic pump group (n=26).The basic information of patients,analgesic drug scores,analgesic links and pathways,analgesic drug use,adverse reactions and related costs were collected for risk analysis,and cost-effectiveness analysis was used for economic evaluation of the two different schemes.Results In the analgesic scores of the two groups,the average score of analgesic pump group was higher than non-analgesic pump group (2.88 vs 2.07) at 1 day after surgery.The difference was statistically significant (P<0.05).The significant relief rate of pain in analgesic pump group in 48 h was 87.72%,and non-analgesic pump group was 80.76%.There was no statistically significant difference between the two groups (P>0.05).The proportion of the non-analgesic pump group using tramadol was higher,and 14 cases (53.84%) did not use opioids,which could effectively save the dosage of opioids.The average number of days of using parecoxib in the non-analgesic pump group was 6.34 days,which was higher than 5.46 days in the analgesic pump group.The proportion of overdose cases of parecoxib was 50.00%,which was higher than 26.31% in the analgesic pump group.The ratio of non-steroidal drug combination cases was 53.84%,which was lower than 85.08% in the analgesic pump group,with statistically significant difference (P<0.05).In the 48 hour cost-effectiveness assessment,the analgesic pump group needed to spend 21.97 yuan to obtain 1% unit of analgesic effect,which was higher tha

关 键 词：胸腔镜术后 镇痛泵 风险调查 成本效果分析 老年患者 

分 类 号：R956[医药卫生—药学]