连续股神经阻滞与患者自控静脉镇痛在全膝关节置换术后应用成本的比较

Comparison of cost-effectiveness between continuous femoral nerve block and patient-controlled intravenous analgesia for postoperative analgesia in patients undergoing unilateral total knee arthroplasty

目的 比较连续股神经阻滞（CFNB）和患者自控静脉镇痛（PCIA）在全膝关节置换术后镇痛的经济成本。方法 择期行单侧全膝关节置换术患者280例,年龄40~75岁,采用随机数字表法均分为两组,每组140例。PCIA组行常规PCIA,CFNB组在超声联合神经刺激仪引导下行CFNB。计算患者满意度评分,总镇痛医疗成本,术后总直接医疗成本及相应的成本-效果比值（CER）。结果 最终PCIA组123例,CFNB组127例纳入研究。与PCIA组比较,CFNB组人均满意度评分明显提高,人均总镇痛医疗成本明显增加,术后人均总直接医疗成本明显降低,总镇痛CER明显增加,总直接CER明显降低（P〈0.05）。结论 与PCIA比较,CFNB具有更好的成本-效果,兼具临床实用性和卫生经济学价值。

Objective To evaluate cost-effectiveness between continuous femoral nerve block （CFNB） and patient-controlled intravenous analgesia （PCIA） for postoperative analgesia in patients undergoing unilateral total knee arthroplasty （TKA）. Methods A total of 280 patients, aged 40-75 yr, scheduled for TKA were randomly divided into 2 groups （n= 140 each）. Femoral nerve block guided by ultrasound combined with nerve stimulator was performed in group CFNB, and group PCIA was administrated with PCIA for 3 days respectively. The analgesia-related direct costs, average direct costs and cost-effect ratio （CER） were recorded. Results The analgesic costs in group CFNB （n = 127） were higher than those in group PCIA （n= 123）, whereas the average direct costs were significantly reduced in group CFNB （P〈0. 05）. CER of analgesia was higher while CER of direct costs was lower in group CFNB （1036 vs. 609 yuan for analgesic costs, 8655 vs. 10492 yuan for direct costs） （P〈0. 05）. Conclusion The use of CFNB has clinical and economic benefits for patients receiving unilateral total replacement surgery.