基于卫生技术评估的针刺治疗继发性痛经的综合评价  

Comprehensive Evaluation of Acupuncture for Secondary Dysmenorrhea Based on Health Technology Assessment

作　　者：吴雪 李知然 胡晶[3] 廖星[1] 孙伟伟[2] WU Xue;LI Zhiran;HU Jing;LIAO Xing;SUN Weiwei(Center for Evidence-based Chinese Medicine,Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing Institute of Traditional Chinese Medicine,Beijing Evidence-based Chinese Medicine Center,Beijing 100191,China)

机构地区：[1]中国中医科学院中医临床基础医学研究所循证医学基础研究室,北京100700 [2]中国中医科学院广安门医院,北京100053 [3]首都医科大学附属北京中医医院,北京市中医药研究所,北京中医药循证医学中心,北京100191

出　　处：《中国实验方剂学杂志》2025年第9期165-174,共10页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82174239);中国中医科学院科技创新工程项目(CI2021A02401,CI2021A00701-3,CI2021A05503);中国中医药循证医学中心“业务研究室主任专项”(2020YJSZX-2);。

摘　　要：目的:该研究旨在开展针刺治疗由子宫腺肌病、子宫内膜异位症导致的继发性痛经(SD)的卫生技术评估(HTA),以期为相关医疗决策提供参考依据。方法:从卫生体系视角出发,开展针刺治疗SD的技术特性、安全性、有效性、经济性、伦理公平性、组织适应性、患者与社会共7个领域的评估并报告结果。结果:针刺技术操作规范且使用条件明确;针刺的总体不良反应发生率更低,不良事件主要集中部位疼痛、皮下出血、头晕等,大多症状较轻,均有相应处理标准;未见职业安全与环境安全相关报告,有可遵照的安全操作规范;相对于常规西药,针刺的有效率更高;针刺可改善患者生活质量评分,但与常规西药比较差异无统计学意义;针刺相比常规西药成本不低,但总体经济性更高;知情同意信息比较充分,大部分患者了解针刺治疗可能的好处与风险并自愿使用;治疗过程充分尊重患者隐私与人权;针刺临床应用遵循当前针刺医疗服务模式,对于应用的医疗机构水平无特殊要求,患者可获得性和可负担性适宜;患者满意度较高,大多数患者表示会再次选择使用针刺治疗SD,选择针刺的阻碍因素主要为心理问题(如害怕针刺)、费用问题和交通不便;针刺治疗的患者使用医保报销人数接近七成,报销比例大多在50%以上,社会保障较高。结论:运用中医药HTA实施规范开展针刺治疗SD的HTA具有可行性。实施步骤明确,各评估指标数据来源较为充足,分析方法可行,评估结果较为全面,专家推荐该结果可以作为相关医疗决策的参考依据。Objective:To carry out a health technology assessment(HTA)of acupuncture for secondary dysmenorrhea(SD)caused by adenomyosis and endometriosis,in order to provide a reference for relevant medical decision-making.Methods:From the perspective of the health system,the assessment covers seven areas,including the technical characteristics,safety,effectiveness,economics,ethical fairness,organizational adaptability,and impact on patients and society.The results are reported accordingly.Results:The operational specifications of acupuncture are standardized,and the conditions for its use are clearly defined.Acupuncture has a lower overall incidence of adverse events.The main adverse events are localized pain,subcutaneous bleeding,and dizziness,with most symptoms being mild,all of which have corresponding standard treatments.No reports on occupational or environmental safety were found,and the safety operation specifications are available for reference.Compared with conventional Western medicine,acupuncture demonstrates higher effectiveness.Acupuncture may improve the quality of life scores of patients,though no significant difference was observed.The cost of acupuncture is higher than that of conventional Western medicine,but its overall economic value is greater.The informed consent information is relatively comprehensive.Most patients are aware of the potential benefits and risks of acupuncture and voluntarily opt for it.The treatment process fully respects patient privacy and human rights.The clinical application of acupuncture follows the current acupuncture medical service model,with no special requirements for the level of medical institutions.Patient accessibility and affordability are suitable.Patient satisfaction is high.Most patients indicated they would choose acupuncture again for SD.The main barriers to choosing acupuncture are psychological factors(such as fear of acupuncture),cost,and transportation issues.Nearly 70%of patients receiving acupuncture treatment benefit from medical insurance reimbursement,wit

关 键 词：卫生技术评估 针刺 继发性痛经 子宫内膜异位症 子宫腺肌病 综合评价 

分 类 号：R256[医药卫生—中医内科学] R287[医药卫生—中医学] R271.113