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guideline Registration for Transparency, PREPARE\uff09\u8fdb\u884c\u6ce8\u518c\uff0c\u6ce8\u518c\u53f7PREPARE-2023CN627\u3002\u65b9\u6cd5\u5b66\u7ec4\u8054\u5408\u5171\u8bc6\u79d8\u4e66\u7ec4\u5171\u540c\u5236\u5b9a\u6587\u732e\u68c0\u7d22\u7b56\u7565\uff0c\u91c7\u7528\u81ea\u7531\u8bcd\u4e0e\u4e3b\u9898\u8bcd\u76f8\u7ed3\u5408\u7684\u65b9\u5f0f\u8fdb\u884c\u68c0\u7d22\u3002\u4e2d\u6587\u68c0\u7d22\u8bcd\u5305\u62ec\u201c\u9547\u9759\u201d\u3001\u201c\u9547\u75db\u201d\u3001\u201c\u8c35\u5984\u201d\u3001\u201c\u6025\u8bca\u201d\u7b49\uff0c\u82f1\u6587\u68c0\u7d22\u8bcd\u5305\u62ec\u201canalgesia\u201d\u3001\u201csedation\u201d\u3001\u201cdelirium\u201d\u3001\u201cemergency\u201d\u7b49\u3002\u68c0\u7d22\u6570\u636e\u5e93\u5305\u62ec\u4e2d\u5916\u6570\u636e\u5e93\uff0c\u4e2d\u6587\u6570\u636e\u5e93\u9009\u62e9\u4e2d\u56fd\u77e5\u7f51\u3001\u4e07\u65b9\u533b\u5b66\u548c\u4e2d\u56fd\u751f\u7269\u533b\u5b66\u6587\u732e\u6570\u636e\u5e93\uff0c\u5916\u6587\u6570\u636e\u5e93\u9009\u62e9Medline\u3001Embase\u548cCochrane library\uff0c\u68c0\u7d22\u65f6\u95f4\u622a\u6b622022\u5e7406\u670830\u65e5\u3002\u68c0\u7d22\u5b8c\u6210\u540e\u65b9\u6cd5\u5b66\u7ec4\u8fdb\u884c\u6587\u732e\u7b5b\u67e5\u548c\u6587\u732e\u9605\u8bfb\uff0c\u7eb3\u5165\u6025\u8bca\u9547\u75db\u3001\u9547\u9759\u3001\u8c35\u5984\u76f8\u5173\u6587\u732e\uff0c\u5bf9\u7eb3\u5165\u6587\u732e\u8fdb\u884c\u8d28\u91cf\u8bc4\u4ef7\uff0c\u53ca\u8bc1\u636e\u6c47\u603b\u3002<\/p>\n<p>\u6839\u636e\u7f8e\u56fd\u725b\u6d25\u5faa\u8bc1\u533b\u5b66\u4e2d\u5fc3 (Oxford centre for evidence-based medicine)\u7684\u8bc1\u636e\u5206\u7ea7\u6c34\u5e73\u53ca\u63a8\u8350\u4f9d\u636e\u5bf9\u5171\u8bc6\u610f\u89c1\u8fdb\u884c\u5206\u7ea7[23]\uff1a1\u7ea7\uff0c\u6765\u81ea\u591a\u4e2a\u968f\u673a\u8bd5\u9a8c\u6216Meta\u5206\u6790\u7684\u6570\u636e\uff1b2\u7ea7\uff0c\u6765\u81ea\u5355\u4e2a\u968f\u673a\u8bd5\u9a8c\u6216\u5927\u6837\u672c\u975e\u968f\u673a\u7814\u7a76\u7684\u6570\u636e\uff1b3\u7ea7\uff0c\u6765\u81ea\u56de\u987e\u6027\u7814\u7a76\u3001\u4e2a\u6848\u7814\u7a76\u7684\u6570\u636e\uff1b4\u7ea7\uff0c\u4e13\u5bb6\u610f\u89c1(\u5305\u62ec\u63cf\u8ff0\u6027\u7efc\u8ff0)\u3002&nbsp; &nbsp;&nbsp;<\/p>\n<p>\u91c7\u7528\u5171\u8bc6\u4f1a\u8bae\u6cd5[24]\uff0c\u57fa\u4e8e\u6587\u732e\u83b7\u5f97\u7684\u56fd\u5185\u5916\u9547\u75db\u3001\u9547\u9759\u3001\u8c35\u5984\u4e34\u5e8a\u8bca\u6cbb\u5faa\u8bc1\u533b\u5b66\u8bc1\u636e\uff0c\u7ed3\u5408\u4e13\u5bb6\u7ec4\u7684\u4e34\u5e8a\u8bca\u6cbb\u7ecf\u9a8c\u548c\u6211\u56fd\u56fd\u60c5\uff0c\u901a\u8fc7\u7ebf\u4e0a\u4f1a\u8bae\u3001\u73b0\u573a\u8ba8\u8bba\u3001\u6295\u7968\u7b49\u65b9\u5f0f\uff0c\u53cd\u590d\u8ba8\u8bba\u3001\u4fee\u6539\uff0c\u6700\u7ec8\u5f97\u51fa\u4e00\u81f4\u6027\u7a0b\u5ea6\u8f83\u9ad8\u7684\u63a8\u8350\u610f\u89c1\u3002\u6309\u7167\u4e13\u5bb6\u63a8\u8350\u7684\u7a0b\u5ea6\u5212\u5206\u4e3a\u5f3a\u70c8\u63a8\u8350\u3001\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\u3001\u5f31\u63a8\u8350\u4e09\u4e2a\u7ef4\u5ea6\uff0c\u6700\u7ec8\u8fbe\u6210\u201c\u6025\u8bca\u6210\u4eba\u9547\u75db\u3001\u9547\u9759\u4e0e\u8c35\u5984\u7ba1\u7406\u4e13\u5bb6\u5171\u8bc6\u201d\u3002<\/p>\n<p>3 \u5171\u8bc6\u63a8\u8350<\/p>\n<p>3.1 \u75bc\u75db\u4e0e\u9547\u75db<\/p>\n<p>\u95ee\u98981\uff1a\u6025\u8bca\u5e38\u7528\u7684\u75bc\u75db\u8bc4\u4f30\u65b9\u6cd5\u6709\u54ea\u4e9b\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c11\uff1a\u80fd\u8a00\u8bed\u8868\u8fbe\u4e14\u65e0\u8ba4\u77e5\u969c\u788d\u7684\u6025\u8bca\u6210\u4eba\u60a3\u8005\u5efa\u8bae\u91c7\u7528\u6570\u5b57\u8bc4\u5206\u6cd5\uff08numeric rating scale, NRS\uff09\uff1b\u65e0\u6cd5\u8a00\u8bed\u6216\u6709\u8ba4\u77e5\u969c\u788d\u7684\u6210\u4eba\u6e05\u9192\u60a3\u8005\u5efa\u8bae\u91c7\u7528FLACC\uff08face legs activity cry consolability, FLACC\uff09\u91cf\u8868\uff1b\u660f\u8ff7\u6216\u610f\u8bc6\u4e0d\u6e05\u7684\u60a3\u8005\u5efa\u8bae\u91c7\u7528\u75bc\u75db\u91cf\u8868\uff08behavioral pain scale, BPS\uff09\u3002\uff082\u7ea7\uff0c\u5f3a\u70c8\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a\u5728\u9009\u62e9\u75bc\u75db\u8bc4\u4f30\u65b9\u6cd5\u65f6\u5e94\u7efc\u5408\u8003\u8651\u60a3\u8005\u7684\u5404\u9879\u6761\u4ef6\uff0c\u5305\u62ec\u8ba4\u77e5\u3001\u60c5\u611f\u3001\u8bed\u8a00\u548c\u6587\u5316\u80cc\u666f\u7b49\u7b49\u3002\u76ee\u524d\u5e38\u7528\u7684\u8bc4\u4f30\u65b9\u6cd5\u6709\uff1a<\/p>\n<p>\u6570\u5b57\u8bc4\u5206\u6cd5\uff08NRS\uff0c\u9644\u88681\uff09\uff0cFLACC\u91cf\u8868\uff08\u9644\u88682\uff09\uff0cBPS\u91cf\u8868\uff08\u9644\u88683\uff09\u3002\u5bf9\u4e8e\u65e0\u8ba4\u77e5\u969c\u788d\u7684\u6210\u4eba\u60a3\u8005\u91c7\u7528NRS\uff0c\u8be5\u91cf\u8868\u53ef\u4ee5\u53e3\u5934\u6216\u4e66\u9762\u5f62\u5f0f\u63d0\u4f9b\uff0c\u8981\u6c42\u60a3\u8005\u6839\u636e0\u5206\uff08\u65e0\u75bc\u75db\uff09\u5230 10\u5206\uff08\u53ef\u60f3\u8c61\u7684\u6700\u4e25\u91cd\u75bc\u75db\uff09\u5bf9\u75bc\u75db\u5f3a\u5ea6\u8fdb\u884c\u8bc4\u5206\u3002\u8f7b\u5ea6\u75bc\u75db\u7684\u8bc4\u5206\u4e3a1-3\u5206\uff0c\u4e2d\u5ea6\u75bc\u75db\u8bc4\u5206\u4e3a4-6\u5206\uff0c\u91cd\u5ea6\u75bc\u75db\u8bc4\u5206\u22657\u5206\u3002NRS\u76f8\u8f83\u4e8e\u5176\u4ed6\u91cf\u8868\u66f4\u5bb9\u6613\u8ba9\u60a3\u8005\u7406\u89e3\uff0c\u5e76\u4e14\u8bc4\u4f30\u5feb\u901f\u6709\u6548\uff0c\u4e0d\u9700\u8981\u60a3\u8005\u63d0\u4f9b\u5176\u4ed6\u590d\u6742\u7684\u4fe1\u606f\uff0c\u4f46\u662f\u8bed\u8a00\u4ee5\u53ca\u6587\u5316\u80cc\u666f\u53ef\u80fd\u4f1a\u5bf9\u8bc4\u4f30\u9020\u6210\u5f71\u54cd\u3002\u56e0\u6b64\uff0c\u5bf9\u4e8e\u65e0\u6cd5\u8a00\u8bed\u8868\u8fbe\u6216\u6709\u8ba4\u77e5\u969c\u788d\u7684\u6210\u4eba\uff0cFLACC\u91cf\u8868\u8bc4\u4f30\u53ef\u80fd\u66f4\u6709\u6548\u3002\u5bf9\u4e8e\u660f\u8ff7\u6216\u610f\u8bc6\u4e0d\u6e05\u7684\u60a3\u8005\uff0cBPS\u662f\u6700\u6709\u6548\u548c\u53ef\u9760\u7684\u75bc\u75db\u8bc4\u4f30\u65b9\u6cd5\uff0c\u4f46\u5176\u7279\u5f02\u6027\u548c\u654f\u611f\u6027\u4f1a\u53d7\u5230\u9762\u90e8\u8868\u60c5\u3001\u80a2\u4f53\u8fd0\u52a8\u3001\u808c\u5f20\u529b\u3001\u673a\u68b0\u901a\u6c14\u53ca\u5916\u90e8\u58f0\u97f3\u7b49\u56e0\u7d20\u7684\u5f71\u54cd\u3002\u9664\u4e86\u5e94\u7528\u5408\u9002\u7684\u8bc4\u4f30\u5de5\u5177\u4e4b\u5916\uff0c\u8fd8\u53ef\u4ee5\u6839\u636e\u4ea4\u611f\u795e\u7ecf\u5174\u594b\u7684\u4f53\u5f81\uff08\u5982\u5fc3\u7387\u52a0\u5feb\u3001\u8840\u538b\u5347\u9ad8\u3001\u51fa\u6c57\u7b49\uff09\u534f\u52a9\u75bc\u75db\u7684\u8bc4\u4f30\u3002<\/p>\n<p>\u95ee\u98982\uff1a\u54ea\u4e9b\u6025\u8bca\u60a3\u8005\u9700\u8981\u9547\u75db\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c12\uff1a\u75bc\u75db\u5728\u6025\u8bca\u60a3\u8005\u4e2d\u5f88\u5e38\u89c1\uff0c\u5f53\u60a3\u8005\u5b58\u5728\u75bc\u75db\u65f6\uff0c\u5e94\u7ed3\u5408\u4e3b\u8bc9\u548c\u75bc\u75db\u8bc4\u5206\u7ed3\u679c\uff0c\u7ed9\u4e88\u6070\u5f53\u7684\u9547\u75db\u6cbb\u7597\u3002\uff083\u7ea7\uff0c\u5f3a\u70c8\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a\u75bc\u75db\u5728\u6025\u8bca\u60a3\u8005\u4e2d\u975e\u5e38\u666e\u904d\uff0c\u7ea660%-90%\u7684\u60a3\u8005\u5b58\u5728\u75bc\u75db\u3002\u6839\u636e\u75bc\u75db\u539f\u56e0\u4e0d\u540c\uff0c\u53ef\u5206\u4e3a\u5916\u4f24\u75db\u3001\u764c\u6027\u75bc\u75db\u3001\u795e\u7ecf\u75c5\u7406\u6027\u75bc\u75db\u3001\u64cd\u4f5c\u6027\u75bc\u75db\u7b49\u3002\u6839\u636e\u75bc\u75db\u90e8\u4f4d\u4e0d\u540c\uff0c\u53ef\u5206\u4e3a\u5934\u9888\u75db\u3001\u80f8\u80cc\u75db\u3001\u8179\u75db\u3001\u8170\u75db\u3001\u56db\u80a2\u5173\u8282\u75db\u7b49\u3002\u4f20\u7edf\u89c2\u70b9\u8ba4\u4e3a\uff1a\u5728\u75bc\u75db\u539f\u56e0\u672a\u660e\u786e\u4e4b\u524d\u4f7f\u7528\u9547\u75db\u5242\uff0c\u53ef\u80fd\u4f1a\u63a9\u76d6\u75c5\u60c5\u3001\u6539\u53d8\u4f53\u5f81\uff0c\u5f71\u54cd\u533b\u62a4\u4eba\u5458\u5bf9\u75be\u75c5\u7684\u51c6\u786e\u5224\u65ad\uff0c\u751a\u81f3\u53ef\u80fd\u5bfc\u81f4\u8bef\u8bca\u3001\u8bef\u6cbb\u3002\u4f46\u591a\u9879\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u8868\u660e\uff0c\u4e0e\u5b89\u6170\u5242\u5bf9\u7167\u7ec4\u76f8\u6bd4\uff0c\u65e9\u671f\u3001\u6b63\u786e\u5730\u4f7f\u7528\u963f\u7247\u7c7b\u9547\u75db\u5242\u4e0d\u4ec5\u53ef\u4ee5\u660e\u663e\u51cf\u8f7b\u60a3\u8005\u7684\u75bc\u75db\u3001\u6539\u5584\u60a3\u8005\u7684\u611f\u53d7\uff0c\u4e14\u4e0d\u4f1a\u5bf9\u8bca\u65ad\u7684\u51c6\u786e\u6027\u4ea7\u751f\u5f71\u54cd\uff0c\u7f8e\u56fd\u533b\u5e08\u534f\u4f1a\u5efa\u8bae\u5728\u60a3\u8005\u611f\u5230\u75bc\u75db\u65f6\u5373\u5f00\u59cb\u5b9e\u65bd\u9547\u75db\u3002\u56e0\u6b64\uff0c\u5728\u63a5\u8bca\u4e0d\u540c\u539f\u56e0\u5bfc\u81f4\u75bc\u75db\u7684\u60a3\u8005\u65f6\uff0c\u5e94\u8be5\u8fdb\u884c\u5feb\u901f\u51c6\u786e\u7684\u521d\u6b65\u8bc4\u4f30\u53ca\u8bca\u65ad\uff0c\u4ee5\u4fbf\u53ca\u65f6\u8fdb\u884c\u9002\u5f53\u7684\u75bc\u75db\u7ba1\u7406\u3002\u5f53NRS\u22651\u3001FLACC\u22651\u6216BPS\u22654\u65f6\u63d0\u793a\u60a3\u8005\u5b58\u5728\u75bc\u75db\uff0c\u5e94\u7ed3\u5408\u60a3\u8005\u672c\u4eba\u4e3b\u8bc9\u548c\u9547\u75db\u9700\u6c42\uff0c\u7ed9\u4e88\u5408\u7406\u7684\u9547\u75db\u3002\u6b64\u5916\uff0c\u4e0d\u540c\u75be\u75c5\u7684\u9547\u75db\u65b9\u5f0f\u4e5f\u5b58\u5728\u4e00\u5b9a\u5dee\u5f02\uff0c\u5bf9\u4e8e\u7ed3\u77f3\u7b49\u75bc\u75db\u5267\u70c8\u4e14\u8bca\u65ad\u8f83\u4e3a\u786e\u5207\u3001\u65e0\u751f\u547d\u5371\u9669\u6216\u8005\u75c5\u60c5\u53ef\u80fd\u4f1a\u6025\u5267\u53d8\u5316\u7684\u75be\u75c5\uff0c\u5e94\u5f53\u65e9\u671f\u9547\u75db\u540e\u518d\u5b8c\u5584\u8f85\u52a9\u68c0\u67e5\uff1b\u5bf9\u4e8e\u6025\u8179\u75c7\u60a3\u8005\uff0c\u5728\u521d\u6b65\u95ee\u8bca\u548c\u67e5\u4f53\u540e\u8fdb\u884c\u9002\u5f53\u6b62\u75db\u662f\u5408\u7406\u7684\u3002\u4efb\u4f55\u60a3\u8005\u7684\u75bc\u75db\u5904\u7406\u90fd\u5e94\u9075\u5faa\u75c5\u60c5\u8bc4\u4f30-\u9547\u75db-\u518d\u8bc4\u4f30\u7684\u539f\u5219\u3002<\/p>\n<p>\u95ee\u98983\uff1a\u6025\u8bca\u60a3\u8005\u5982\u4f55\u5b9e\u65bd\u9547\u75db\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c13.1\uff1a\u5bf9\u4e8e\u9700\u8981\u9547\u75db\u7684\u6025\u8bca\u60a3\u8005\uff0c\u5efa\u8bae\u5728\u5904\u7406\u539f\u53d1\u75be\u75c5\u7684\u540c\u65f6\uff0c\u7ed9\u4e88\u975e\u836f\u7269\u548c\/\u6216\u836f\u7269\u9547\u75db\u3002\uff084\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a<\/p>\n<p>\u6025\u8bca\u60a3\u8005\u7684\u75bc\u75db\u901a\u5e38\u4e0e\u539f\u53d1\u75be\u75c5\u76f8\u5173\uff0c\u56e0\u6b64\u5728\u8bca\u6cbb\u539f\u53d1\u75be\u75c5\u7684\u540c\u65f6\uff0c\u5e94\u8bc4\u4f30\u60a3\u8005\u7684\u75bc\u75db\uff0c\u7ed9\u4e88\u9002\u5f53\u7684\u9547\u75db\uff0c\u5e76\u8003\u8651\u4e2a\u4f53\u60a3\u8005\u7684\u83b7\u76ca\u548c\u98ce\u9669\uff0c\u5408\u7406\u9009\u62e9\u975e\u836f\u7269\u548c\/\u6216\u836f\u7269\u63aa\u65bd\u3002<\/p>\n<p>\uff081\uff09\u975e\u836f\u7269\u6cbb\u7597\uff1a\u5305\u62ec\u5fc3\u7406\u758f\u5bfc\u3001\u5206\u6563\u6ce8\u610f\u529b\u3001\u8bf1\u5bfc\u653e\u677e\u3001\u51b7\u70ed\u7597\u6cd5\u548c\u60c5\u611f\u652f\u6301\u7b49\uff0c\u4ee5\u53ca\u9aa8\u6298\u7684\u5916\u56fa\u5b9a\u3001\u7275\u5f15\u3001\u652f\u6491\u7b49\u3002\uff082\uff09\u836f\u7269\u6cbb\u7597\uff1a\u2460\u975e\u753e\u4f53\u7c7b\u6297\u708e\u836f\uff08nonsteroidal anti-inflammatory drugs\uff0cNSAIDs\uff09\uff0c\u5305\u62ec\u5e03\u6d1b\u82ac\u3001\u585e\u6765\u6614\u5e03\u3001\u5432\u54da\u7f8e\u8f9b\u3001\u6c1f\u6bd4\u8bfa\u915a\u916f\u3001\u5e15\u745e\u6614\u5e03\u94a0\u7b49\uff1b\u2461\u963f\u7247\u7c7b\uff1a\u5982\u5417\u5561\u3001\u82ac\u592a\u5c3c\u3001\u7f9f\u8003\u916e\u3001\u745e\u82ac\u592a\u5c3c\u3001\u8212\u82ac\u592a\u5c3c\u3001\u6c22\u5417\u5561\u916e\u3001\u7eb3\u5e03\u5561\u3001\u55b7\u4ed6\u4f50\u8f9b\u3001\u5730\u4f50\u8f9b\u3001\u5e03\u6258\u5561\u8bfa\u3001\u53ef\u5f85\u56e0\u3001\u66f2\u9a6c\u591a\u7b49\uff1b\u2462\u5176\u4ed6\u7c7b\u522b\uff0c\u5305\u62ec\u5bf9\u4e59\u9170\u6c28\u57fa\u915a\u3001\u6c2f\u80fa\u916e\u3001\u827e\u53f8\u6c2f\u80fa\u916e\u7b49\uff1b\u2463\u5c40\u90e8\u9ebb\u9189\u836f\u7c7b\uff0c\u5305\u62ec\u5229\u591a\u5361\u56e0\u3001\u7f57\u54cc\u5361\u56e0\u3001\u5e03\u6bd4\u5361\u56e0\u7b49\uff1b\u2464\u5916\u7528\u6b62\u75db\u5236\u5242\uff0c\u5305\u62ec\u53cc\u6c2f\u82ac\u9178\u4e8c\u4e59\u80fa\u4e73\u80f6\u5242\u3001\u4e91\u5357\u767d\u836f\u6c14\u96fe\u5242\u7b49\u3002\u6709\u6761\u4ef6\u7684\u533b\u9662\u8fd8\u53ef\u5e94\u7528\u4e2d\u533b\u9547\u75db\u3002\u5e38\u7528\u9547\u75db\u836f\u7269\u7684\u7528\u6cd5\u3001\u7528\u91cf\u63a8\u8350\u8be6\u89c1\u9644\u88684\u3001\u9644\u88685\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c13.2\uff1a\u5bf9\u4e8e\u8f7b\u5ea6\u75bc\u75db\uff08NRS\/FLACC 1-3\u5206\u3001BPS 4-6\u5206\uff09\uff0c\u5728\u975e\u836f\u7269\u6cbb\u7597\u57fa\u7840\u4e0a\uff0c\u9996\u9009\u5bf9\u4e59\u9170\u6c28\u57fa\u915a\u6216\u975e\u753e\u4f53\u7c7b\u6297\u708e\u836f\uff1b\u5bf9\u4e8e\u4e2d\u5ea6\u75bc\u75db\uff08NRS\/FLACC 4-6\u5206\u3001BPS 7-9\u5206\uff09\uff0c\u9996\u9009\u5bf9\u4e59\u9170\u6c28\u57fa\u915a\uff0c\u5982\u75bc\u75db\u65e0\u7f13\u89e3\uff0c\u53ef\u4ee5\u8054\u7528\u975e\u753e\u4f53\u7c7b\u3001\u53e3\u670d\u963f\u7247\u7c7b\u836f\u7269\uff1b\u5bf9\u4e8e\u91cd\u5ea6\u75bc\u75db\uff08NRS\/FLACC 7-10\u5206\uff1bBPS 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795e\u72b6\u6001\u4e0d\u7a33\u5b9a\u6216\u5b58\u5728\u81ea\u6740\u98ce\u9669\u7684\u60a3\u8005\uff0c\u63a5\u53d7\u5176\u4ed6\u836f\u7269\u6cbb\u7597\u3001\u53ef\u80fd\u56e0\u836f\u7269\u76f8\u4e92\u4f5c\u7528\u800c\u5bfc\u81f4\u4e0d\u826f\u5e76\u53d1\u75c7\u7684\u60a3\u8005\uff0c\u4ee5\u53ca\u7531\u4e8e\u6210\u763e\u800c\u5bfb\u6c42\u963f\u7247\u7c7b\u836f\u7269\u7684\u60a3\u8005\uff0c\u5e94\u8c28\u614e\u4f7f\u7528\u963f\u7247\u7c7b\u836f\u7269\u3002\u6025\u8bca\u9547\u75db\u7684\u6d41\u7a0b\u8be6\u89c1\u56fe1\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c13.3\uff1a\u5bf9\u4e8e\u5c40\u90e8\u7684\u521b\u4f24\u6027\u75bc\u75db\u6216\u6e05\u521b\u7f1d\u5408\u3001\u7a7f\u523a\u7b49\u64cd\u4f5c\u65f6\u7684\u9547\u75db\uff0c\u5efa\u8bae\u8fdb\u884c\u5145\u5206\u7684\u5c40\u90e8\u9ebb\u9189\uff082\u7ea7\uff0c\u5f3a\u70c8\u63a8\u8350\uff09\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c13.4\uff1a\u5bf9\u4e8e\u4e0a\u4e0b\u80a2\u9aa8\u6298\u3001\u5173\u8282\u8131\u4f4d\u6216\u5173\u8282\u8131\u4f4d\u7684\u590d\u4f4d\u7b49\uff0c\u5efa\u8bae\u9002\u5f53\u91c7\u7528\u5916\u5468\u795e\u7ecf\u963b\u6ede(peripheral nerve blockade, PNB)\u3001\u9ac2\u7b4b\u819c\u95f4\u9699\u963b\u6ede(fascia iliaca compartment block, 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28\uff0c\u5e76\u505a\u597d\u547c\u5438\u5faa\u73af\u652f\u6301\u7684\u6280\u672f\u4fdd\u969c\uff0c\u5bf9\u4e8e\u4e25\u91cd\u7684\u75bc\u75db\u5efa\u8bae\u91c7\u7528\u591a\u6a21\u5f0f\u9547\u75db\u3002\uff083\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a\u963f\u7247\u7c7b\u836f\u7269\u901a\u8fc7\u4f5c\u7528\u03ba\u53d7\u4f53\uff0c\u4ea7\u751f\u6297\u80c6\u78b1\u80fd\u6d3b\u6027\uff0c\u4f7f\u60a3\u8005\u4ea7\u751f\u55dc\u7761\u75c7\u72b6\u3002\u901a\u8fc7\u6fc0\u52a8\u03bc\u53d7\u4f53\uff0c\u964d\u4f4e\u4e86\u5927\u8111\u547c\u5438\u4e2d\u67a2\u5316\u5b66\u611f\u53d7\u5668\u5bf9\u4e8c\u6c27\u5316\u78b3\u7684\u53cd\u5e94\u6027\uff0c\u4ea7\u751f\u547c\u5438\u6291\u5236\u3002\u4f7f\u7528\u963f\u7247\u7c7b\u836f\u7269\u65f6\uff0c\u5fc5\u987b\u52a0\u5f3a\u76d1\u6d4b\u5e76\u6ef4\u5b9a\u7ed9\u836f\uff0c\u907f\u514d\u836f\u7269\u8fc7\u91cf\u3002\u5982\u679c\u51fa\u73b0\u55dc\u7761\u3001\u547c\u5438\u6291\u5236\uff0c\u6216\u8003\u8651\u53d1\u751f\u6025\u6027\u4e2d\u6bd2\uff0c\u9996\u5148\u4fdd\u8bc1\u60a3\u8005\u7684\u547c\u5438\u5faa\u73af\u5b89\u5168\uff0c\u7ed9\u4e88\u963f\u7247\u62ee\u6297\u5242\u7eb3\u7edc\u916e\uff0c\u82e5\u75c7\u72b6\u65e0\u6539\u5584\uff0c\u53ef2 min-3 min\u540e\u91cd\u590d\u7ed9\u836f\uff0c\u76f4\u5230\u60a3\u8005\u75c7\u72b6\u5f97\u5230\u6539\u5584\u3002\u4e0a\u8ff0\u6cbb\u759710min\u5185\u4ecd\u65e0\u6548\u4e14\u7eb3\u7edc\u916e\u603b\u7528\u91cf\u8fbe\u52301mg\uff0c\u5e94\u8003\u8651\u662f\u5426\u6709\u5176\u4ed6\u539f\u56e0\u6240\u81f4\u7684\u547c\u5438\u6291\u5236\u53ef\u80fd\u3002\u963f\u7247\u7c7b\u836f\u7269\u8fd8\u53ef\u5bfc\u81f4\u80c3\u80a0\u9053\u53cd\u5e94\u5305\u62ec\u4fbf\u79d8\u3001\u80c3\u98df\u7ba1\u53cd\u6d41\u75c5\u3001\u6076\u5fc3\u3001\u5455\u5410\u3001\u8179\u80c0\u548c\u8179\u75db\uff0c\u4ee5\u53ca\u6210\u763e\u7b49\u3002\u56e0\u6b64\uff0c\u5e94\u5c3d\u53ef\u80fd\u51cf\u5c11\u963f\u7247\u7c7b\u836f\u7269\u7684\u4f7f\u7528\u91cf\uff0c\u5fc5\u8981\u65f6\u66f4\u6362\u4e3a\u5176\u4ed6\u9547\u75db\u836f\u7269\uff0c\u540c\u65f6\u4f7f\u7528\u8f85\u52a9\u836f\u7269\u4ee5\u51cf\u8f7b\u80c3\u80a0\u9053\u53cd\u5e94\u3002\u5f31\u963f\u7247\u7c7b\u836f\u7269\u53ef\u5f85\u56e0\u548c\u66f2\u9a6c\u591a\u90fd\u662f\u7531CYP2D6\u9176\u4ee3\u8c22\u540e\u8d77\u6548\u7684\u524d\u4f53\u836f\u7269\uff1b\u5c11\u6570\u60a3\u8005\u65e0CYP2D6\u9176\uff0c\u5bfc\u81f4\u53ef\u5f85\u56e0\u548c\u66f2\u9a6c\u591a\u65e0\u6548\uff1b\u800c\u6709\u4e9b\u60a3\u8005\u662f\u8d85\u5feb\u4ee3\u8c22\u8005\uff0c\u5bfc\u81f4\u4e0d\u53ef\u9884\u6d4b\u7684\u9ad8\u8840\u836f\u6d53\u5ea6\u3002\u56e0\u6b64\uff0c\u4e0d\u5efa\u8bae\u5c06\u53ef\u5f85\u56e0\u3001\u66f2\u9a6c\u591a\u4e0e\u5176\u4ed6\u963f\u7247\u7c7b\u836f\u7269\u8054\u5408\u4f7f\u7528\u3002\u53ef\u5f85\u56e0\u548c\u66f2\u9a6c\u591a\u8868\u73b0\u51fa\u4e0e\u5176\u4ed6\u5e38\u7528\u836f\u7269\uff08\u5982\u6297\u6291\u90c1\u836f\uff0c\u9009\u62e9\u6027\u8840\u6e05\u518d\u5438\u6536\u6291\u5236\u5242[selective serotonin reuptake inhibitor, SSRI]\u548c5-\u7f9f\u8272\u80fa-\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u518d\u6444\u53d6\u6291\u5236\u5242[serotonin-norepinephrine reuptake inhibitor, SNRI]\uff09\u7684\u663e\u8457\u76f8\u4e92\u4f5c\u7528\u3002<\/p>\n<p>3.2 \u8e81\u52a8\u4e0e\u9547\u9759<\/p>\n<p>\u95ee\u98987\uff1a\u6025\u8bca\u6709\u54ea\u4e9b\u5e38\u7528\u7684\u9547\u9759\u8bc4\u4f30\u65b9\u6cd5\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c17\uff1a\u5bf9\u4e8e\u9700\u8981\u5b9e\u65bd\u9547\u9759\u7684\u6025\u8bca\u6210\u4eba\u60a3\u8005\uff0c\u5efa\u8bae\u4f7f\u7528Richmond\u9547\u9759\u8e81\u52a8\u8bc4\u5206\uff08richmond agitation sedation scale\uff0cRASS\uff09\u6216\u9547\u9759\u8e81\u52a8\u8bc4\u5206 (sedation-agitation scale\uff0cSAS)\u8fdb\u884c\u8e81\u52a8\u8bc4\u4f30\uff08\u9644\u88689\u300110\uff09\u3002\uff082\u7ea7\uff0c\u5f3a\u70c8\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a\u76ee\u524d\u5e38\u7528\u7684\u4e3b\u89c2\u9547\u9759\u8bc4\u5206\u6cd5\u6709RASS\u3001Ramsay\u8bc4\u5206\u3001SAS\uff0c\u5ba2\u89c2\u8bc4\u4f30\u65b9\u6cd5\u6709\u8111\u7535\u53cc\u9891\u6307\u6570\uff08bispectral index, BIS\uff09\u3001\u808c\u8089\u6d3b\u52a8\u8bc4\u5206\u6cd5\uff08motor activity assessment scale, MAAS\uff09\u7b49\u3002\u76ee\u524dRASS\u548cSAS\u6cd5\u56e0\u5176\u7b80\u5355\u3001\u6613\u64cd\u4f5c\u800c\u88ab\u63a8\u8350\u5e76\u5e7f\u6cdb\u5e94\u7528\u4e8e\u4e34\u5e8a\uff0c\u5e76\u80fd\u6307\u5bfc\u9547\u9759\u836f\u7269\u5242\u91cf\u7684\u8c03\u6574\u30022019\u5e74\u7684\u4e00\u9879\u7814\u7a76\u7eb3\u5165290\u540d\u60a3\u8005\uff0c\u7814\u7a76\u4eba\u5458\u53ca\u62a4\u58eb\u4f7f\u7528Ramsay \u8bc4\u5206\u548cRASS\u8bc4\u5206\u5bf9\u9547\u9759\u6548\u679c\u8fdb\u884c\u8bc4\u4f30\uff0c\u7ed3\u679c\u8868\u660eRASS\u8bc4\u5206\u5728\u4e34\u5e8a\u5b9e\u8df5\u4e2d\u8f83Ramsay 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-1\u81f30\u5206\u3002\uff083\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u610f\u89c110.2\uff1a\u5bf9\u4e8e\u4e25\u91cd\u547c\u5438\u8870\u7aed\u3001\u547c\u5438\u673a\u62ee\u6297\u3001\u63a5\u53d7\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\u6cbb\u7597\u3001\u766b\u75eb\u6301\u7eed\u72b6\u6001\u3001\u4e25\u91cd\u8111\u635f\u4f24\u4f34\u6709\u9885\u5185\u9ad8\u538b\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u7ed9\u4e88\u4e2d\u6df1\u5ea6\u9547\u9759\uff0c\u76ee\u6807RASS -3\u81f3-4\u5206\u3002\uff084\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u610f\u89c110.3\uff1a\u5bf9\u4e8e\u9700\u8981\u4ecb\u5165\u64cd\u4f5c\u4e14\u5b58\u5728\u4eba\u5de5\u6c14\u9053\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u7ed9\u4e88\u4e2d\u6df1\u5ea6\u9547\u9759\uff0c\u76ee\u6807RASS -3\u81f3-4\u5206\uff1b\u5bf9\u4e8e\u65e0\u4eba\u5de5\u6c14\u9053\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u6d45\u9547\u9759\uff0c\u76ee\u6807RASS -1\u81f30\u5206\u3002\uff083\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a<\/p>\n<p>\u7814\u7a76\u53d1\u73b0\u6d45\u9547\u9759\uff08RASS\u3002\u5bf9\u4e8e\u60a3\u8005\u51fa\u73b0\u660e\u663e\u7684\u8e81\u52a8\u53ca\u7126\u8651\u75c7\u72b6\uff0cRASS\u76ee\u6807\u5efa\u8bae -1\u81f30\u5206\u3002\u5982\u679c\u9547\u75db\u548c\u6d45\u9547\u9759\u4e0d\u80fd\u4f7f\u60a3\u8005\u8fbe\u5230\u5e73\u9759\u4e0e\u5408\u4f5c\uff0c\u5e94\u9996\u5148\u786e\u5b9a\u539f\u56e0\u5e76\u8fdb\u884c\u7ea0\u6b63\uff0c\u518d\u8003\u8651\u91c7\u7528\u4e2d\u6df1\u9547\u9759\u3002\u5bf9\u4e8e\u4e25\u91cd\u547c\u5438\u8870\u7aed\u3001\u547c\u5438\u673a\u62ee\u6297\u3001\u63a5\u53d7\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\u6cbb\u7597\u3001\u766b\u75eb\u6301\u7eed\u72b6\u6001\u3001\u67d0\u4e9b\u9700\u8981\u4e25\u683c\u9547\u9759\u7684\u5916\u79d1\u624b\u672f\u72b6\u6001\u3001\u4e25\u91cd\u8111\u635f\u4f24\u4f34\u6709\u9885\u5185\u9ad8\u538b\u7684\u60a3\u8005\uff0c\u4e2d\u6df1\u5ea6\u9547\u9759\u4ecd\u7136\u662f\u9996\u9009\u65b9\u6848\u3002\u8fd9\u4e9b\u60a3\u8005\u5982\u679c\u9009\u62e9\u4e86\u6d45\u9547\u9759\uff0c\u53ef\u80fd\u4f1a\u589e\u52a0\u60a3\u8005\u7684\u6c27\u8017\uff0c\u52a0\u91cd\u75c5\u60c5\uff0c\u56e0\u6b64\u9700\u8981\u8f83\u6df1\u7684\u9547\u9759\u76ee\u6807\uff08RASS-3\u81f3-4\u5206\uff09\u3002<\/p>\n<p>\u95ee\u989811\uff1a\u6025\u8bca\u60a3\u8005\u7684\u9547\u9759\u5982\u4f55\u8fdb\u884c\u76d1\u6d4b\u4e0e\u8bc4\u4f30\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c111.1\uff1a\u5efa\u8bae\u5bf9\u5b9e\u65bd\u836f\u7269\u9547\u9759\u7684\u6025\u8bca\u60a3\u8005\u8fdb\u884c\u5e38\u89c4\u8bc4\u4f30\u548c\u76d1\u6d4b\uff0c\u5305\u62ec\u610f\u8bc6\u72b6\u6001\u3001\u547c\u5438\u529f\u80fd\u3001\u5faa\u73af\u529f\u80fd\uff0c\u540c\u65f6\u76d1\u6d4b\u9547\u9759\u6df1\u5ea6\uff0c\u5e76\u5efa\u8bae\u533b\u62a4\u5171\u540c\u53c2\u4e0e\u3002\uff083\u7ea7\uff0c\u5f3a\u70c8\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u610f\u89c111.2\uff1a\u5bf9\u4e8e\u75be\u75c5\u7684\u9547\u9759\uff0c\u5efa\u8bae\u521d\u6b21\u7ed9\u4e88\u9547\u9759\u836f\u7269\u540e30min\u5185\u8fdb\u884c\u590d\u8bc4\uff0c\u4e4b\u540e\u6bcf\u96942h\u8fdb\u884c\u8bc4\u4f30\uff0c\u75c5\u60c5\u53d8\u5316\u65f6\u968f\u65f6\u8bc4\u4f30\u3002\uff084\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u610f\u89c111.3\uff1a\u5bf9\u4e8e\u6709\u521b\u64cd\u4f5c\u7684\u9547\u9759\uff0c\u5efa\u8bae\u64cd\u4f5c\u8fc7\u7a0b\u4e2d\u52a8\u6001\u8bc4\u4f30\uff0c\u64cd\u4f5c\u7ed3\u675f\u65f6\u3001\u7ed3\u675f\u540e15min\u590d\u8bc4\u3002\uff084\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u610f\u89c111.4\uff1a\u5bf9\u4e8e\u68c0\u67e5\u7684\u9547\u9759\uff0c\u5efa\u8bae\u68c0\u67e5\u8fc7\u7a0b\u4e2d\u968f\u65f6\u5173\u6ce8\u751f\u547d\u4f53\u5f81\uff0c\u68c0\u67e5\u7ed3\u675f\u540e15min\u590d\u8bc4\u3002\uff084\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a<\/p>\n<p>\u9547\u9759\u836f\u7269\u4f1a\u5bfc\u81f4\u547c\u5438\u6291\u5236\u3001\u4f4e\u8840\u538b\u3002\u5e94\u7528\u9547\u9759\u836f\u7269\u65f6\uff0c\u5fc5\u987b\u5bc6\u5207\u76d1\u6d4b\uff1a\uff081\uff09\u610f\u8bc6\u72b6\u6001\u3001\u60a3\u8005\u53cd\u5e94\u7b49\uff1b\uff082\uff09\u547c\u5438\u9891\u7387\u3001\u547c\u6c14\u672b\u4e8c\u6c27\u5316\u78b3\u3001\u8840\u6c27\u9971\u548c\u5ea6\u7b49\uff1b\uff083\uff09\u5faa\u73af\u529f\u80fd\u3001\u8840\u538b\u3001\u5fc3\u7387\u3001\u5fc3\u7535\u56fe\u7b49\uff1b\uff084\uff09\u9547\u9759\u6df1\u5ea6\uff0c\u4f7f\u7528\u9547\u9759\u8bc4\u4f30\u5de5\u5177\uff08RASS\u6216SAS\uff09\u8bc4\u4f30\u9547\u9759\u6df1\u5ea6\u3002\u8fd8\u53ef\u901a\u8fc7\u8111\u7535\u53cc\u9891\u6307\u6570\uff08bispectral index, BIS\uff09\u3001\u75c5\u4eba\u72b6\u6001\u6307\u6570\uff08patient state index, PSI\uff09\u3001\u542c\u89c9\u8bf1\u53d1\u7535\u4f4d\uff08auditory evoked potentials\uff0cAEPs\uff09\u3001\u8111\u529f\u80fd\uff08brain function\uff09\u76d1\u6d4b\u4eea\u548c\u53cd\u5e94\u71b5\uff08reaction entropy, RE\uff09\u76d1\u6d4b\u4eea\u5bf9\u60a3\u8005\u7684\u8111\u529f\u80fd\u8fdb\u884c\u6d4b\u91cf\uff0c\u76d1\u6d4b\u9547\u9759\u6df1\u5ea6\u3002<\/p>\n<p>\u95ee\u989812\uff1a\u6025\u8bca\u9547\u9759\u6709\u54ea\u4e9b\u5e76\u53d1\u75c7\u53ca\u5982\u4f55\u9884\u9632\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c112\uff1a\u9547\u9759\u836f\u7269\u7684\u5e38\u89c1\u5e76\u53d1\u75c7\u5305\u62ec\u547c\u5438\u6291\u5236\u3001\u4f4e\u8840\u538b\u3001\u6212\u65ad\u75c7\u72b6\u7b49\u3002\u6025\u8bca\u5e94\u7528\u9547\u9759\u836f\u7269\u65f6\uff0c\u5efa\u8bae\u4ee5\u6700\u5c0f\u5242\u91cf\u3001\u6700\u77ed\u65f6\u95f4\u3001\u6ef4\u5b9a\u65b9\u5f0f\u8fdb\u884c\u9547\u9759\uff0c\u5e76\u505a\u597d\u547c\u5438\u5faa\u73af\u652f\u6301\u7684\u6280\u672f\u4fdd\u969c\u3002\uff083\u7ea7\uff0c\u4e2d\u7b49\u5f3a\u5ea6\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a\u9547\u9759\u836f\u7269\u5bf9\u547c\u5438\u7684\u6291\u5236\u4f5c\u7528\u4e0e\u8f93\u6ce8\u901f\u7387\u548c\u5242\u91cf\u76f8\u5173\uff0c\u4e0e\u82ac\u592a\u5c3c\u6216\u8212\u82ac\u592a\u5c3c\u7b49\u963f\u7247\u7c7b\u9547\u75db\u836f\u5408\u7528\u65f6\uff0c\u53ef\u52a0\u91cd\u547c\u5438\u6291\u5236\u7684\u53d1\u751f\uff0c\u56e0\u800c\u5728\u5408\u7528\u65f6\u5e94\u4e25\u5bc6\u76d1\u6d4b\uff0c\u6700\u5c0f\u5242\u91cf\u3001\u6700\u77ed\u65f6\u95f4\u8f93\u6ce8\uff0c\u5e76\u8fdb\u884c\u6ef4\u5b9a\u3002\u5bf9\u4e8e\u65e0\u4eba\u5de5\u6c14\u9053\u7684\u60a3\u8005\u8981\u505a\u597d\u6c14\u7ba1\u63d2\u7ba1\u3001\u547c\u5438\u652f\u6301\u7684\u51c6\u5907\u3002\u4f4e\u8840\u538b\u4e5f\u662f\u9547\u9759\u836f\u7269\u5e38\u89c1\u7684\u5e76\u53d1\u75c7\u3002\u6b64\u5916\uff0c\u957f\u65f6\u95f4\u5e94\u7528\u9547\u9759\u836f\u7269\u540e\u7a81\u7136\u505c\u836f\u6216\u5feb\u901f\u51cf\u91cf\uff0c\u5747\u53ef\u80fd\u5f15\u8d77\u6212\u65ad\u7efc\u5408\u5f81\u3002\u9488\u5bf9\u6025\u8bca\u4f7f\u7528\u9547\u9759\u836f\u7269\u7684\u5e76\u53d1\u75c7\u9884\u9632\uff0c\u5305\u62ec\u4ee5\u4e0b\u63aa\u65bd\uff1a\uff081\uff09\u9547\u9759\u524d\u5168\u9762\u7684\u8bc4\u4f30\uff1a\u5305\u62ec\u5168\u9762\u4e86\u89e3\u65e2\u5f80\u533b\u7597\u548c\u624b\u672f\u53f2\u3001\u786e\u5b9a\u76f8\u5173\u7684\u5408\u5e76\u75c7\u3001\u60a3\u8005\u7528\u836f\u548c\u8fc7\u654f\u53f2\u3001\u4f7f\u7528\u5408\u7406\u7684\u9547\u9759\u8bc4\u4f30\u5de5\u5177\u7b49\u3002\u64cd\u4f5c\u65f6\u9547\u9759\u53ef\u80fd\u5b58\u5728\u547c\u5438\u6291\u5236\u548c\u6c14\u9053\u5b89\u5168\u7684\u98ce\u9669\uff0c\u5fc5\u987b\u5145\u5206\u8bc4\u4f30\u60a3\u8005\u6c14\u9053\u5b89\u5168\u6027\uff0c\u9884\u5907\u7403\u56ca-\u9762\u7f69\u901a\u6c14\u548c\u6c14\u7ba1\u63d2\u7ba1\u3002\uff082\uff09\u9009\u62e9\u9002\u5f53\u7684\u836f\u7269\uff1a\u5e94\u5c3d\u53ef\u80fd\u4f7f\u7528\u6700\u5c11\u7684\u5e72\u9884\uff0c\u836f\u7269\u5e94\u4ee5\u5c0f\u5242\u91cf\u7ed9\u836f\u6216\u901a\u8fc7\u8fde\u7eed\u8f93\u6ce8\u6ef4\u5b9a\u5230\u4e34\u5e8a\u6548\u679c\u3002\uff083\uff09\u4e25\u5bc6\u7684\u76d1\u6d4b\uff1a\u76d1\u6d4b\u548c\u8bb0\u5f55\u9547\u9759\u540e\u5fc3\u7387\u3001\u8840\u538b\u3001\u547c\u5438\u9891\u7387\u3001\u8109\u640f\u6c27\u9971\u548c\u5ea6\u548c\u9547\u9759\/\u610f\u8bc6\u6c34\u5e73\u7684\u53d8\u5316\u3002<\/p>\n<p>3.3 \u8c35\u5984<\/p>\n<p>\u95ee\u989813\uff1a\u6025\u8bca\u60a3\u8005\u662f\u5426\u9700\u8981\u8fdb\u884c\u8c35\u5984\u8bc4\u4f30\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c113\uff1a\u5efa\u8bae\u5bf9\u6025\u8bca\u533a\u57df\u5177\u6709\u8c35\u5984\u9ad8\u5371\u56e0\u7d20\u7684\u60a3\u8005\u8fdb\u884c\u8c35\u5984\u8bc4\u4f30\uff082\u7ea7\uff0c\u5f3a\u70c8\u63a8\u8350\uff09\u3002\u63a8\u8350\u7406\u7531\uff1a\u8c35\u5984\u5728\u6025\u8bca\u5c31\u8bca\u7684\u8001\u5e74\u60a3\u8005\u4e2d\u5f88\u5e38\u89c1\uff088%-10%\uff09\uff0c\u5c24\u5176\u662f75\u5c81\u4ee5\u4e0a\u7684\u8001\u5e74\u4eba\u3002\u5728\u6025\u8bca\uff0c\u5408\u5e76\u8c35\u5984\u7684\u60a3\u8005\u75c5\u6b7b\u7387\u589e\u52a0\u3001\u4f4f\u9662\u65f6\u95f4\u5ef6\u957f\u3001\u5668\u5b98\u529f\u80fd\u4e0b\u964d\u3001\u8ba4\u77e5\u969c\u788d\u548c\u533b\u7597\u6210\u672c\u589e\u52a0\uff0c\u9884\u540e\u8f83\u5dee\u3002\u6025\u8bca\u60a3\u8005\u8c35\u5984\u7684\u6f0f\u8bca\u7387\u9ad8\uff0857%-83%\uff09\uff0c\u53ef\u80fd\u4e0e\u9ad8\u8fbe90%\u7684\u60a3\u8005\u8868\u73b0\u4e3a\u60c5\u7eea\u4f4e\u843d\u578b\u8c35\u5984\u53ca\u6025\u8bca\u5c31\u8bca\u73af\u5883\u76f8\u5173\u3002\u5728\u6025\u8bca\u7b5b\u67e5\u786e\u5b9a\u8c35\u5984\u7684\u9ad8\u5371\u60a3\u8005\u5c06\u6709\u52a9\u4e8e\u65e9\u671f\u5b9e\u65bd\u5e72\u9884\u63aa\u65bd\uff0c\u4ece\u800c\u6539\u5584\u60a3\u8005\u9884\u540e\u3002\u8c35\u5984\u7684\u6613\u611f\u548c\u8bf1\u53d1\u56e0\u7d20\u5305\u62ec\u9ad8\u9f84\u3001\u547c\u5438\u8870\u7aed\u3001\u5faa\u73af\u8870\u7aed\u3001\u8113\u6bd2\u75c7\u3001\u4ee3\u8c22\u7d0a\u4e71\uff08\u4f4e\u8840\u7cd6\u3001\u9ad8\/\u4f4e\u94a0\u8840\u75c7\u3001\u5c3f\u6bd2\u75c7\u548c\u9ad8\u6c28\u8840\u75c7\u7b49\uff09\u3001\u63a5\u53d7\u7cbe\u795e\u836f\u7269\u6cbb\u7597\uff0c\u957f\u671f\u5236\u52a8\u3001\u672a\u77eb\u6b63\u7684\u89c6\u529b\u548c\u542c\u529b\u7f3a\u9677\u3001\u7761\u7720\u5265\u593a\u4ee5\u53ca\u4e0e\u4eb2\u4eba\u9694\u7edd\u7b49\u3002\u56e0\u6b64\uff0c\u5728\u6025\u8bca\u73af\u5883\u4e2d\u9700\u8981\u5bf9\u9ad8\u5371\u60a3\u8005\u3001\u7279\u522b\u662f\u8001\u5e74\u60a3\u8005\u8fdb\u884c\u79ef\u6781\u7684\u8c35\u5984\u7b5b\u67e5\uff0c\u53ca\u65f6\u7ea0\u6b63\u5371\u9669\u56e0\u7d20\uff0c\u79ef\u6781\u5e72\u9884\uff0c\u4ee5\u6539\u5584\u9884\u540e\u3002<\/p>\n<p>\u95ee\u989814\uff1a\u6025\u8bca\u5e38\u7528\u7684\u8c35\u5984\u8bc4\u4f30\u65b9\u6cd5\u6709\u54ea\u4e9b\uff1f<\/p>\n<p>\u63a8\u8350\u610f\u89c114\uff1a\u5bf9\u4e8e\u5177\u6709\u8c35\u5984\u9ad8\u5371\u56e0\u7d20\u6216\u610f\u8bc6\u72b6\u6001\u7a81\u53d1\u6539\u53d8\u7684\u60a3\u8005\uff0c\u6392\u9664\u5668\u8d28\u6027\u75c5\u53d8\u540e\uff0c\u5efa\u8bae\u91c7\u7528\u7b80\u660e\u610f\u8bc6\u6a21\u7cca\u8bc4\u4f30\u6cd5 (brief confusion review method\uff0cBCAM)\u8fdb\u884c\u8c35\u5984\u8bc4\u4f30\u3002\uff082\u7ea7\uff0c\u5f3a\u70c8\u63a8\u8350\uff09<\/p>\n<p>\u63a8\u8350\u7406\u7531\uff1a\u7b80\u660e\u610f\u8bc6\u6a21\u7cca\u8bc4\u4f30\u6cd5(BCAM\uff0c\u9644\u56fe1)\u7531Inouye\u7b49\u4e8e1990\u5e74\u63d0\u51fa\uff0c\u4e0d\u8d85\u8fc71min\u5373\u53ef\u5b8c\u6210\uff0c\u8bc4\u4f30\u662f\u5426\u5b58\u5728\u4ee5\u4e0b\u56db\u4e2a\u5f81\u8c61\uff1a\uff081\uff09\u610f\u8bc6\u72b6\u6001\u6025\u6027\u6539\u53d8\u6216\u6ce2\u52a8\uff1b\uff082\uff09\u6ce8\u610f\u529b\u4e0d\u96c6\u4e2d\uff1b\uff083\uff09\u610f\u8bc6\u6c34\u5e73\u6539\u53d8\uff1b\uff084\uff09\u601d\u7ef4\u7d0a\u4e71\u3002\u5982\u679c\u60a3\u8005\u540c\u65f6\u5b58\u5728\u5f81\u8c611\u548c\u5f81\u8c612\uff0c\u4e14\u5f81\u8c613\u6216\u8005\u5f81\u8c614\u5b58\u5728\u5176\u4e2d\u4e00\u6761\uff0c\u5219\u8ba4\u4e3a\u8be5\u60a3\u8005\u5b58\u5728\u8c35\u5984\u3002Baten\u7b49\u5728\u5fb7\u56fd\u4e00\u4e2a\u5927\u578b\u6025\u8bca\u79d1\u4e2d\u91c7\u7528BCAM\uff0c\u7531\u6025\u8bca\u533b\u751f\u572870\u5c81\u4ee5\u4e0a\u7684\u60a3\u8005\u4e2d\u5bf9\u5176\u6709\u6548\u6027\u8fdb\u884c\u8bc4\u4f30\uff0c\u5e76\u4e0e\u57fa\u4e8e\u300a\u7cbe\u795e\u969c\u788d\u8bca\u65ad\u548c\u7edf\u8ba1\u624b\u518c\u300b\u4e2d\u63cf\u8ff0\u7684\u8c35\u5984\u6807\u51c6\u8fdb\u884c\u6bd4\u8f83\uff0c\u7ed3\u679c\u8868\u660eBCAM\u5177\u6709\u826f\u597d\u7684\u7279\u5f02\u602793.8%\uff0895%CI\u4e3a90.0%-96.5%\uff09\uff0c\u654f\u611f\u6027\u4e3a65.2%\uff0895%CI\u4e3a49.8%-78.7%\uff09\u3002\u53e6\u4e00\u9879\u524d\u77bb\u6027\u3001\u89c2\u5bdf\u6027\u7814\u7a76\u5bf9\u8001\u5e74\u7ec8\u672b\u671f\u75be\u75c5\u60a3\u8005\u53d1\u73b0\uff0c 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