切口浸润与自控镇痛在腹腔镜阑尾切除术后应用成本的比较

Comparison of the Cost of Incision Infiltration and Self-controlled Analgesia after Laparoscopic Appendectomy

目的:比较罗哌卡因切口浸润与自控静脉镇痛在腹腔镜阑尾切除手术后镇痛的成本-效果比值(CER)。方法:120例急诊腹腔镜阑尾切除术患者采用随机数字表法均分为2组,各60例,浸润麻醉组(A组):0.75%罗哌卡因切口浸润,每个切口2ml;自控镇痛组(B组):镇痛泵使用舒芬太尼2μg/kg、咪达唑仑10mg、托烷司琼10mg用0.9%生理盐水配制共100ml,用静脉镇痛,背景量2ml/h,自控给药剂量0.5ml/次,锁定时间15min。记录拔管后各时段的NRS评分、其他止痛药和不良反应。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CER。结果:与B组比较,A组术后48h内静息状态与运动状态NRS评分无明显区别(P>0.05),不良反应发生率明显减少(P<0.05),患者总体满意度明显提高,人均总镇痛成本及术后总直接医疗成本、相应的CER均明显降低(P<0.05)。结论:罗哌卡因切口浸润在腹腔镜阑尾切除术后镇痛中具有更好的CER,临床实用性强,卫生经济学价值更好。

Objective：To compare the analgesic effect of ropivacaine infiltration incision resection ratio cost after surgery and patientcontrolled intravenous analgesia in laparoscopic appendectomy（CER）.Methods：120 cases of emergency laparoscopic appendectomy were randomly divided into 2 groups,each of 60 cases,infiltration anesthesia group（A group）：0.75%ropivacaine infiltration incision,incision of each 2ml;analgesia group（B group）：analgesia sufentanil 2μg/kg,midazolam,10 mg support tropisetron with 0.9%10mg normal saline100 ml,intravenous analgesia,background 2ml/h,automatic dosing 0.5ml/,lock time 15 min.The NRS score,other analgesics and adverse reactions were recorded after extubation.The patient satisfaction score,the total cost of analgesia,the total direct medical costs and the corresponding CER.Results：Compared with B group,A group after 48 h in the resting state and the motion state of the NRS score had no significant difference（P〉0.05）,the incidence of adverse reactions was significantly reduced（P〈0.05）,the overall satisfaction of patients was obviously improved,the per capita total cost of analgesia and postoperative total direct medical cost,the corresponding CER were significantly decreased（P〈0.05）.Conclusion：Ropivacaine infiltration has better CER incision in laparoscopic appendectomy after analgesia,the clinical practical value of better health economics.