剖宫产术后两种镇痛方案临床疗效及经济学比较

Comparison of Clinical Efficacy and Economics of Two Different Analgesia Schemes on Post-Cesarean Delivery

目的为临床剖宫产术后镇痛方案的选择提供参考。方法选取医院2020年6月至2021年4月剖宫产术后拟使用静脉泵镇痛的产妇80例,按镇痛方案的不同分为A组B组,各40例,分别经静脉泵予地佐辛注射液15~20 mg及枸橼酸舒芬太尼注射液45~100μg,均联合氟比洛芬酯注射液100~150 mg,静脉泵速率2 mL/h,给药24 h;比较两种方案的镇痛效果、患者满意度及不良反应发生率。采用成本-效果分析法对两种方案进行经济学评价,并以敏感性分析评估经济学评价结果的可靠性。结果两组产妇术后6 h、12 h、24 h、48 h静息与活动状态下的疼痛数字评分量表(NRS)评分均无显著差异(P>0.05),A组术后24 h NRS评分达标率为75.00%,与B组的70.00%相当(P>0.05)。两组各有2例产妇(5.00%)追加镇痛药物。A组与B组满意度(97.50%比92.50%,P>0.05)及不良反应发生率(17.50%比12.50%,P>0.05)均相当。成本-效果分析结果显示,A组每多获得1单位有效率需花费18.54元,与B组的成本-效果比为57.24。敏感性分析结果显示,A组相对B组的增量成本-效果比为51.52。结论剖宫产术后采用本研究中两种镇痛方案均有良好的镇痛疗效与安全性,但氟比洛芬酯与舒芬太尼联合相较与地佐辛联合更具有经济学优势。

Objective To provide a reference for the choice of post-cesarean delivery analgesia scheme.Methods A total of 80 puerperae who planned to use the intravenous pump for analgesia after cesarean section in the hospital from June 2020 to April 2021 were selected and divided into group A and group B according to different analgesic schemes,with 40 cases in each group.The puerperae in group A and group B were given 15-20 mg of Dezocine Injection and 45-100μg of Sufentanil Citrate Injection respectively via the intravenous pump system,and all the puerperae were given 100-150 mg of Flurbiprofen Axetil Injection via the intravenous pump system,with the intravenous pump rate of 2 mL/h for 24 h.The cost-effectiveness analysis method was used to conduct an economic evaluation on the two schemes,and the sensitivity analysis was used to evaluate the reliability of the economic evaluation results.Results There were no significant differences in the Numeric Rating Scale(NRS)scores at resting and motion state at different time points of 6 h,12 h,24 h and 48 h after the surgery(P>0.05).The rate of reaching the standard of NRS score at 24 h after the surgery in group A was 75.00%,which was similar to 70.00%in group B(P>0.05).Two puerperae(5.00%)in each group received additional analgesics.The satisfaction(97.50%vs.92.50%,P>0.05)and the incidence of adverse drug reactions(17.50%vs.12.50%,P>0.05)in group A and group B were similar.The results of cost-effectiveness analysis showed that it would cost CNY 18.54 for puerperae in group A to obtain additional unit of effective rate,with a cost-effectiveness ratio of 57.24 compared with those in group B.The results of sensitivity analysis showed that the incremental cost-effectiveness ratio of group A to group B was 51.52.Conclusion The two analgesic schemes in this study have good analgesic efficacy and safety on post-cesarean delivery,but flurbiprofen axetil combined with sufentanil has more economic advantages than that of dezocine.