6种方法预防低危患者术后恶心呕吐(PONV)的成本效果分析

 目的 比较6种方法预防相对低危患者在腹腔镜胆囊切除术后发生恶心呕吐的成本和效果。方法 180名择期行腹腔镜胆囊切除术并符合入选标准的男性患者,随机分为6组。组1接受异丙酚靶控输注(target-controlled infusion,TCI)+5 mg托烷司琼;组2接受异丙酚TCI+10 mg地塞米松和1.25 mg氟派利多;组3接受异丙酚TCI+生理盐水;组4接受七氟醚+5 mg托烷司琼;组5接受七氟醚+10 mg地塞米松和1.25 mg氟派利多;组6接受七氟醚+生理盐水。研究终点是术后24 h内恶心呕吐发生的次数,采用盲法记录。结果 各组患者的一般情况、麻醉时间、手术时间、拔管时间和术后24 h的痛觉模拟评分差异均无统计学意义。组2术后恶心呕吐的发生率显著低于组3 (P=0.03),组5显著低于组6 (P=0.01)。 接受托烷司琼和异丙酚或七氟醚发生术后恶心呕吐的相对危险度分别为0.51或0.68;接受地塞米松联合氟哌利多和异丙酚或七氟醚发生术后恶心呕吐的相对危险度分别为0.40或0.39;相对于七氟醚,接受异丙酚麻醉发生术后恶心呕吐的相对危险度是0.80。1~6组每分钟的费用-效果比分别为1.07、0.88、1.14、1.05、0.74 和1.06。结论 异丙酚、托烷司琼、地塞米松和氟哌利多发生术后恶心呕吐的相对危险度不同。6种干预措施中,七氟醚结合地塞米松和氟哌利多具有最低的每分钟费用-效果比。

Cost-effectiveness comparison between 6 interventions for the prevention of postoperative nausea and vomiting (PONV) on low-risk patients

Objective We conducted this study to compare the cost and effectiveness of prophylactic antiemetic interventions combined with different anesthetic techniques on those relative low-risk patients received laparoscopic oholcystectomy (LC).Methods One hundred and eighty male patients fulfilling inclusion criteria scheduled for LC were randomized divided into 6 groups,with 30 patients in each group.Group 1 received target controlled infusion (TCI) of propofol +5 mg tropisetron.Group 2 received TCI propofol +10 mg dexamethasone +1.25 mg droperidol.Group 3 received TCI propofol without antiemetics.Group 4 received sevoflurane +5 mg tropisetron.Group 5 received sevoflurane +10 mg dexamethasone +1.25 mg droperidol.Group 6 received sevoflurane without antiemetic.The primary outcome was nausea and vomiting within 24 hours after surgery,which was evaluated blindly.Results No difference was seen with regard to patient characteristics,time of surgery,anesthesia and extubation and visual analogue score (VAS) for 24 hours after surgery.The incidence of postoperative nausea and vomiting (PONV) in group 2 was significantly lower than in group 3 (P=0.03), and in group 5 was significantly lower than that in group 6 (P=0.01).The relative risk of PONV for those received tropisetron and propofol or sevoflurane were 0.51 or 0.68,for those received dexamethasone,droperidol and propfol or sevoflurane were 0.40 or 0.39,for those received propofol was 0.80.The relative risk of PONV for those received antiemetics were 0.62 compared with those received only anesthetics.Looking at the total cost including waste,the cost-effectiveness ratio per minute was 1.07,0.88,1.14,1.05,0.74 and 1.06 respectively in group 1 to 6.Conclusions Propofol,tropisetron,dexamethasone and droperidol had different relative risk of PONV.Dexamethasone plus droperidol and sevoflurane had the lowest cost-effectiveness ratio per minute.