加速康复外科理念下帕瑞昔布治疗老年髋关节手术患者围术期疼痛的临床综合评价

Clinical comprehensive evaluation of parecoxib for perioperative pain management in elderly patients undergoing hip surgery under the concept of enhanced recovery after surgery

关键词:  帕瑞昔布  疼痛  髋关节手术  老年患者  药品临床综合评价

Key words:  parecoxib  pain  hip surgery  elderly patients  clinical comprehensive evaluation of drug

摘要:

目的 根据药品临床综合评价的要求和方法,在加速康复外科理念下评价帕瑞昔布用于老年髋关节手术患者围术期疼痛治疗中的临床综合价值,为医疗机构药品遴选及合理用药提供参考。方法 首先,通过文献调查法和小组讨论法初步构建安全性、有效性、经济性、适宜性、创新性、可及性6个维度的临床综合评价指标体系；其次采用德尔菲法对评价指标体系的核心内容进行评价和筛选；最后,采用循证医学研究(文献系统评价)、真实世界数据研究( 前瞻性、观察性队列研究) 等方法及药品说明书等信息来源,根据指标体系对帕瑞昔布治疗老年髋关节手术患者围术期疼痛中各指标进行定性及定量整合分析。结果 系统评价结果显示,老年髋关节手术患者围术期使用帕瑞昔布的安全性和有效性优于使用安慰剂及阿片类药物；真实世界研究结果显示老年髋关节手术患者术后使用帕瑞昔布于阿片类药物相比的安全性及有效性更好；经济学方面,老年髋关节手术患者术后使用帕瑞昔布与阿片类药物相比具有成本及效果优势,更具经济性；创新性方面,帕瑞昔布在适应症上及临床用药需求上具有一定的创新潜力,因此创新性一般；适宜性方面,对于护士、药师以及使用本药品的患者来说帕瑞昔布的适宜性较好；可及性方面,帕瑞昔布的医院配备率、市场覆盖率较高,疗程费用占人均消费支出比重较低,可获得性及可负担性较高,可及性较好。结论 帕瑞昔布用于治疗老年髋关节手术患者围术期疼痛时在6个维度上具有较好的表现,其临床综合价值较高。

Abstract:

ABSTRACT: OBJECTIVE According to the requirements and methods of clinical comprehensive evaluation of drugs, the clinical comprehensive value of parecoxib for perioperative pain management in elderly patients undergoing hip surgery is evaluated under the concept of enhanced recovery after surgery, providing a reference for drug selection and rational drug use in medical institutions. METHODS Firstly, a preliminary comprehensive clinical evaluation index system encompassing six dimensions—safety, effectiveness, economy, suitability, innovation, and accessibility—is constructed through literature review and group discussion. Secondly, the Delphi method is employed to evaluate and screen the core content of the evaluation index system. Finally, methods such as evidence-based medical research (systematic review of literature) and real-world data research (prospective, observational cohort study), along with information sources like drug instructions, are utilized to conduct a qualitative and quantitative integrated analysis of the indicators in the perioperative pain management of elderly patients undergoing hip surgery with parecoxib, based on the established index system. RESULTS The results of the systematic review indicate that parecoxib demonstrates superior safety and effectiveness compared to placebo and opioids in the perioperative pain management for elderly patients undergoing hip surgery. Real-world study results further suggest that parecoxib offers better safety and effectiveness than opioids in postoperative pain management for these patients. In terms of economics, parecoxib exhibits cost and effectiveness advantages over opioids in postoperative use for elderly hip surgery patients, making it more economical. In terms of innovation, parecoxib has innovative potential in terms of its indications and clinical medication needs, albeit with moderate innovation. In terms of suitability, parecoxib is well-suited for nurses, pharmacists, and patients using this medication. Regarding accessibility, parecoxib boasts high hospital equipment rates and market coverage, with the cost of a treatment course accounting for a relatively low proportion of per capita consumption expenditure, indicating high availability and affordability, and thus good accessibility. CONCLUSION Parecoxib demonstrates favorable performance across the six dimensions when used for perioperative pain management in elderly patients undergoing hip surgery, indicating its high clinical comprehensive value.