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頁籤選單縮合
題名 | 危急病患2002年鎮靜止痛技術指引的成本效益探討=Cost-Benefit Perspective for 2002 New Guideline in ICU Sedation |
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作者姓名(中文) | 張家昇; 吳世銓; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 4:4 2002.10[民91.10] |
頁次 | 頁261-270 |
分類號 | 418.224 |
關鍵詞 | 加護病房鎮靜; 成本效益評估; ICU sedation; Cost-benefit evaluation; Propofol; Midazolam; Lorazepam; |
語文 | 中文(Chinese) |
中文摘要 | 關於加護病房鎮靜止痛技術的安全與效益,多年來一直是種挑戰,SCCM、ASHP、ACCP共同在西元2002年提出對危急病患臨床使用鎮靜止痛劑的最新指引。鎮靜止痛有助於人工呼吸器的使用、減弱自主神經的壓力反應、並可維持睡眠/清醒週期等效益,使照護更容易,但藥物使用就會有副作用與成本的增加。以往對使用此技術的成本評估常僅於藥品價格,或使用呼吸器日數等直接價格,但對於處理產生的品質成效、副作用、延遲呼吸器脫離,住院及出院生活品質改變的效益等等較少整體探討。雖然已經有更新鎮靜止痛劑如Dexmedetomidine建議使用於加護病房,但2002年的最新指引及文獻還是常用Lorazepam、Midazolam和Propofol分析比較,我們嘗試從文獻中探討,將這些藥品市場價,脫離呼吸器時間、離開加護病房日子改變的影響,血液動力改變的副作用,長短期使用此技術的不同,藥物間的交互作用與副作用,施予此技術的難易等各方面來評估,以提供如何能評估較接近"眞實"成本效益的加護病房鎮靜止痛技術。 |
英文摘要 | The management of agitation in ventilated patients remains a challenge in the ICU. Agitation can lead to increases in morbidity, length of ICU stay and associated increased costs. While management of agitation is essential, the acquisition cost of pharmacological agents with the necessary safety and efficacy may be high. Health care providers may be tempted to conserve limited resources through the use of agents with a lower acquisition cost. Pharmacoeconomics encourages a true estimation of the cost of therapy through consideration of the cost of side effects, lengths of stay and recovery time, quality of life, and acquisition costs. The proper choice of drugs to relieve agitation may differ depending on specific circumstances, including patient factors, disease factors, presence of pain, the potential for drug interactions with concomitantly administered medications, and cost. In order to determine the true cost of sedation of ventilated patients, a number of comparative factors need to be considered: time to extubation, time to ICU transfer, hemodynamic ramifications, indication for short-term versus long-term use, potential drug interactions and adverse drug events, ease of administration, and acquisition costs. Pharmacologic agents with higher acquisition costs may ultimately prove to be more cost-effective when total cost of therapy is considered, particularly if a drug reduces time on the mechanical ventilator and shortens the length of stay in the ICU. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。