术程镇静和镇痛与整体麻醉用于歇斯底里镜性肌肉切除术:与随机对照试验并行的成本效益分析
Julia F van der Meulen1,2, Mohamed El Alili3, Sjors F P J Coppus1
1Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands.
使用程序性镇静和止痛疗法的门诊歇斯托罗斯镜性肌肉切除术与全身麻醉相比,成本效益较高. 虽然没有达到完全纤维瘤切除的非劣质性,但这种方法提供了显著的成本节省.
科学领域:
- 妇科 妇科 妇科 妇科
- 麻醉学 麻醉学
- 卫生经济学 卫生经济学
背景情况:
- 歇斯托拉透视肌肉切除术是对症状类型0和1纤维瘤的首要治疗方法.
- 传统上是在全身麻醉下进行的,手术越来越多地转移到门诊环境,使用手术镇静和止痛.
- 关于这种方法的安全性和成本效益的数据有限.
研究的目的:
- 评估使用基于propofol的手术镇静和止痛疗法在门诊环境下对整体麻醉在手术室中的成本效益.
主要方法:
- 一个多中心随机控制的非劣势试验与社会成本效益分析.
- 209名患有0/1型纤维瘤症状的妇女被随机分配到手术镇静和止痛 (n=106) 或全身麻醉 (n=103).
- 主要结果是完全切除率;次要结果包括社会成本和质量调整后寿命年 (QALYs).
主要成果:
- 完全歇斯底里切除率相似:在程序镇静和镇痛方面为87.8%,在全身麻醉方面为88.8% (未证明非劣势).
- 程序性镇静和镇痛导致成本显著降低 (€-2577的差异).
- 没有观察到QALYs的显著差异,程序镇静和镇痛在全身麻醉中占主导地位.
结论:
- 与全身麻醉相比,在门诊环境中进行透性肌肉切除术的手术镇静和镇痛是具有成本效益的.
- 尽管没有证明完全切除的非劣势性,但显著的成本节省支持其使用.
- 这项研究建议考虑门诊手术镇静和止痛疗法,用于透性肌肉切除术.
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