本文選題：層次分析法　切入點：米氮平　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究采用層次分析法(AHP)對四種抗抑郁藥物(米氮平、文拉法辛、西酞普蘭和舍曲林)進行風險效益評價,運用AHP法建立藥物優(yōu)選模型,得出各個藥物的效益值,風險值,綜合評分值并進行排序,對抑郁癥治療的四種藥物進行優(yōu)選,為臨床合理用藥提供幫助。方法:(1)建立層次結(jié)構(gòu)模型,確定目標層、準則層和方案層�？偰繕藶閿M解決的問題,本研究將抗抑郁藥物的優(yōu)選作為決策總目標;準則層則是為實現(xiàn)總目標而采用的指標,能充分反映抗抑郁藥物的安全性和有效性,本研究分別采用藥物的2周起效率、6周有效率和常見不良反應(yīng)發(fā)生數(shù)量、常見不良反應(yīng)發(fā)生嚴重程度;方案層,即用于解決問題的備選方案,選擇目前臨床常見的四種抗抑郁藥物,分別是米氮平、文拉法辛、西酞普蘭和舍曲林。(2)目標圖建立以后,構(gòu)建對比矩陣,使用1-9評分法確定各個屬性的相對重要性,對準則層的各指標之間,以及方案層對準則層之間,進行兩兩比較并進行指標賦權(quán)和矩陣計算,得出各方案的風險值,效益值和綜合評分。(3)判斷矩陣的一致性檢驗。(4)敏感性分析,使用Expert Choice軟件進行敏感性分析。結(jié)果:通過計算機檢索系統(tǒng)查找相關(guān)數(shù)據(jù)庫,找出待評價藥物近年來的相關(guān)Meta分析文獻,通過Meta分析中有關(guān)起效率、有效率和不良反應(yīng)的結(jié)果,對層次結(jié)構(gòu)模型中的各屬性之間進行兩兩比較和矩陣計算,得出米氮平、文拉法辛、西酞普蘭和舍曲林的綜合評分值分別為0.277、0.273、0.223和0.227。效益值分別為0.313、0.313、0.313、0.063。風險值分別為0.196、0.282、0.354和0.169。各層次的判斷矩陣的一致性比率(CR)均小于0.1,即都通過了一致性檢驗。結(jié)論:綜合評分最高的是米氮平,最低的是西酞普蘭。效益值最低的是舍曲林,風險值最高的是西酞普蘭。效益指標與風險指標均為該研究的敏感性因素,子標準中的2周起效率可在0.077-0.265之間變動,6周有效率可在0.078-0.262之間變動,常見不良反應(yīng)發(fā)生數(shù)量可在0.242-0.314之間變動,常見不良反應(yīng)發(fā)生嚴重程度可在0.021-0.268之間變動,超出范圍會影響四種藥物的綜合評分排序。
[Abstract]:Objective: to evaluate the risk and benefit of four antidepressants (metozapine, venlafaxine, citalopram and sertraline) by analytic hierarchy process (AHP), and to establish the optimal drug selection model by using AHP method, and to obtain the benefit value of each drug. The risk value, the comprehensive score value and the ranking were used to select the four drugs for the treatment of depression so as to provide help for the rational use of drugs in clinical practice. Methods: 1) to establish a hierarchical structure model and determine the target level. The general objective of this study is to make the optimal selection of antidepressants as the overall decision objective, and the criteria layer is the index to achieve the overall goal, which can fully reflect the safety and effectiveness of antidepressants. In this study, we used the effective rate of 6 weeks and the number of common adverse reactions, the severity of common adverse reactions, the program level, the alternatives for solving the problem, and the effective rate of 6 weeks and the number of common adverse reactions, respectively. Four common antidepressants, namely, metozapine, venlafaxine, citalopram and sertraline, were selected. After the establishment of the target map, a comparison matrix was constructed, and the relative importance of each attribute was determined by 1-9 scoring method. The risk value of each scheme is obtained by comparing the indexes of the criterion layer and the criterion layer by comparing the indicators and calculating the matrix. The sensitivity analysis of benefit value and comprehensive score. 3) the consistency test of judgment matrix. The sensitivity analysis was carried out by using Expert Choice software. Results: the relevant database was searched by computer retrieval system. To find out the relevant Meta analysis literature of the drugs to be evaluated in recent years, through the results of the Meta analysis about the efficiency, the effective rate and the adverse reaction, to carry on the pairwise comparison and the matrix calculation among the attributes in the hierarchical structure model, and to obtain the rice nitrogen level. Venlafaxine, The comprehensive scores of citalopram and sertraline were 0.2770.2730.223 and 0.227.The benefit values were 0.3130.3130.3130.63.The risk values were 0.196 / 0.2820.354 and 0.169respectively. The CRs of the judgement matrix of each level were less than 0.1, that is, they passed the consistency test. The highest score was the rice nitrogen level. The lowest is citalopram, the lowest benefit is sertraline, and the highest risk is citalopram. The effective rate varied from 0.077-0.265 in 2 weeks to 0.078-0.262 in 6 weeks, the number of common adverse reactions varied between 0.242 and 0.314, and the severity of common adverse reactions varied from 0.021 to 0.268. Going beyond the range can affect the overall ranking of the four drugs.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R971

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