两种镇痛方式对全膝关节置换术后成本效果的比较 秦珮珮，彭丽桦，任力 ....docxVIP

两种镇痛方式对全膝关节置换术后成本效果的比较 秦珮珮，彭丽桦，任力，闵苏 （400016 重庆，重庆医科大学附属第一医院麻醉科） [摘要] 目的 比较患者自控静脉镇痛和连续股神经阻滞对全膝关节置换术后成本效果的影响。方法 择期行单侧全膝关节置换术患者280例，性别不限，年龄40~75岁，ASA分级Ⅰ－Ⅲ级。采用随机数字表法随机分为两组（n=140）：患者自控静脉镇痛（PCIA）组和连续股神经阻滞（CFNB）组。PCIA组行患者自控静脉镇痛，CFNB组在超声联合神经刺激仪引导下行连续股神经阻滞。分别记录两组患者术后24、48、72h及7d静、动态NRS评分；术后48、72h及7d膝关节活动度；术后平均住院日；患者满意度；术后并发症以及镇痛不良反应发生率；总镇痛医疗成本；术后总直接医疗成本及成本-效果比值。结果 与PCIA组相比，CFNB组患者术后7d运动和静息NRS评分降低（P0.05）；患肢关节活动度增大（P0.05）；术后平均住院日缩短（P0.05）；患者满意度提高（P0.05）；人均总镇痛医疗成本增加（P0.05），术后人均总直接医疗成本降低（P0.05）；总镇痛医疗成本-效果比值增加（P0.05），总直接医疗成本-效果比值降低（P0.05）。结论 与PCIA相比，CFNB能够有效降低术后急性疼痛，有利于早期关节功能锻炼，进而缩短术后住院日，具有更好的成本效果，兼具临床实用性和卫生经济学价值。 [关键词] 成本-效果分析；神经传导阻滞；股神经； 关节成形术；镇痛 Comparison cost-effectiveness between continuous femoral nerve block guided by ultrasound combined with nerve stimulator and patient-controlled intravenous analgesia for postoperative analgesia in patients undergoing unilateral total knee arthroplasty QIN Peipei, PENG Lihua, REN Li, MIN Su (Department of Anesthesiology,The First Hospital of Chongqing Medical University,Chongqing 400016,China.) [Abstract] Objective To evaluate cost-effectiveness between continuous femoral nerve block guided by ultrasound combined with nerve stimulator (CFNB) and patient-controlled intravenous analgesia (PCIA) for postoperative analgesia in patients undergoing unilateral total 基金项目：重庆市卫生局重点项目（2013-1-008）；卫生部国家临床重点专科建设项目[财社（2011）170号]； 重庆市医学重点学科建设项目[渝卫科教（2007）2号][通讯作者] 闵苏， E-mail：m163.comknee arthroplasty (TKA). Methods 280 ASA physical statusⅠ-Ⅲ patients, aged 40-75 yr, scheduled for TKA were randomly divided into 2 groups(n=140 each):CFNB group and PICA group.Femoral nerve block guided by ultrasound combined with nerve stimulator was performed in group CFNB, the group PCIA was administrated with patient-controlled intravenous analgesia for 3 days respectively.The NRS scores at rest and in motion at 24h,48h,72h,7day and knee flexion range at 48h,72h,7day postoperatively ,the complications postoperatively and analgesia-related side effec