地佐辛联合氟比洛芬酯与单用舒芬太尼在术后静脉 自控镇痛中有效性与安全性的meta分析
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摘要
目的采用meta分析评价地佐辛和氟比洛芬酯联合用药与单用舒芬太尼在术后静脉自控镇痛中的有效性与安全性。方法系统检索Pub Med、Web of science、Embase、Cochrane图书馆、CNKI、VIP、Wan Fang、CBMdisc等数据库,收集地佐辛联合氟比洛芬酯术后静脉自控镇痛的随机对照试验(RCT),采用Rev Man 5.3软件进行Meta分析。结果共纳入有效文献11篇,累计936名患者。Meta分析结果显示:(1) VAS评分:联合用药组在术后4 h和8 h的VAS评分均较单用舒芬太尼组低,且差异均具有统计学意义(P <0.05);(2) Ramsay评分:联合用药组在术后36 h镇静效果较单用舒芬太尼更为显著[WMD=0.05,95%CI(0.01,0.10),P=0.02];(3)病人自控镇痛(PCA)有效按压次数:联合用药组在术后24 h和48 h时这两个时间点的PCA有效按压次数较单用舒芬太尼组低[WMD=-1.45,95%CI(-6.04,3.01),P<0.01;WMD=-1.52,95%CI(-6.20,3.18),P <0.01];(4)安全性:与舒芬太尼单用组相比,联合用药组术后恶心呕吐、皮肤瘙痒及总发生率显著降低。结论与单用舒芬太尼相比,地佐辛复合氟比洛芬酯用于静脉自控镇痛(PCIA)能获得较好的临床镇痛效果,并有效降低不良发应发生率,临床应用更为安全。
Objective To evaluate the efficacy and safety of dezocine combined with flurbiprofen axetil versus sufenta for patient-controlled analgesia(PCA). Methods The randomized controlled trials of dezocine combined with flurbiprofen axetil for PCA were gathered from PubMed, Web of science, Embase, Cochrane library, CNKI, VIP, Wan Fang and CBMdisc Data. After data extraction and quality assessment of the included RCTs, Rev Man 5.3 software was used in the meta-analysis. Results Eleven trials comprising 936 patients were included in the meta-analysis.(1) Compared with the sufentanil group, the visual analog scale(VAS) score of the combination group had significant differences at 4-hour and 8-hour post-operation;(2) Compared with the sufentanil group, the ramsay sedation score at 24-hour and 48-hour had significant differences when dezocine was combined with flurbiprofen axetil(WMD = 0.05, 95%CI(0.01, 0.10), P = 0.02);(3) As for the effective number of press in the PCA, the combined group was better than the single sufentanil group at 24 h and 48 h [WMD =-1.45, 95%CI(-6.04, 3.01), P < 0.01; WMD =-1.52, 95%CI(-6.20, 3.18), P < 0.01];(4) Comparision of adverse reactions in the combination group with those of the single sufentanil group, nausea and vomiting, skin itching and incidences of adverse reaction were all significantly decreased. ConclusionAccording to domestic evidence, dezocine combined with flurbiprofen axetil for PCA may more effectively alleviate post-operative pain than sufentanil alone, and can reduce the incindence of adverse reactions.
Objective To evaluate the efficacy and safety of dezocine combined with flurbiprofen axetil versus sufenta for patient-controlled analgesia(PCA). Methods The randomized controlled trials of dezocine combined with flurbiprofen axetil for PCA were gathered from PubMed, Web of science, Embase, Cochrane library, CNKI, VIP, Wan Fang and CBMdisc Data. After data extraction and quality assessment of the included RCTs, Rev Man 5.3 software was used in the meta-analysis. Results Eleven trials comprising 936 patients were included in the meta-analysis.(1) Compared with the sufentanil group, the visual analog scale(VAS) score of the combination group had significant differences at 4-hour and 8-hour post-operation;(2) Compared with the sufentanil group, the ramsay sedation score at 24-hour and 48-hour had significant differences when dezocine was combined with flurbiprofen axetil(WMD = 0.05, 95%CI(0.01, 0.10), P = 0.02);(3) As for the effective number of press in the PCA, the combined group was better than the single sufentanil group at 24 h and 48 h [WMD =-1.45, 95%CI(-6.04, 3.01), P < 0.01; WMD =-1.52, 95%CI(-6.20, 3.18), P < 0.01];(4) Comparision of adverse reactions in the combination group with those of the single sufentanil group, nausea and vomiting, skin itching and incidences of adverse reaction were all significantly decreased. ConclusionAccording to domestic evidence, dezocine combined with flurbiprofen axetil for PCA may more effectively alleviate post-operative pain than sufentanil alone, and can reduce the incindence of adverse reactions.
引文
[1]申乐,黄宇光.规范化术后多模式镇痛治疗对加速腹盆部手术后康复的意义[J].中国医学科学院学报,2016,38(4):458-463.
[2]朱剑宇,荚卫东,许戈良,等.帕瑞昔布钠联合芬太尼多模式镇痛对原发性肝癌患者围术期免疫功能的影响[J].中华普通外科杂志,2016,31(2):117-120.
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[9]周萍.地佐辛联合氟比洛芬酯用于老年髋关节置换患者术后镇痛的临床研究[J].世界临床药物,2014,35(11):683-685,709.
[10]奚高原,孟睿,李青春,等.地佐辛复合氟比洛芬酯用于肺癌根治术术后镇痛的临床研究[J].医药论坛杂志,2014,36(6):154-156.
[11]张新科.地佐辛伍用氟比洛芬酯在开胸患者术后PCIA中的应用[J].中国医学工程,2014,22(12):104-105,108.
[12]徐守才,扈智多,陈红,等.不同自控静脉镇痛方案在开胸术后镇痛效果的观察[J].临床麻醉学杂志,2014,30(7):679-681.
[13]李冰,黄宁,王志刚,等.地佐辛联合氟比洛芬酯用于老年肿瘤患者开胸手术术后的镇痛效果[J].临床麻醉学杂志,2013,29(10):1007-1008.
[14]范海哲,张婧杰.不同剂量地佐辛复合氟比洛芬酯在下肢骨折手术术后镇痛的效果[J].临床麻醉学杂志,2014,30(10):1001-1004.
[15]谢峥嵘,孟宪慧,周俊辉.多模式镇痛在老年患者开胸手术后镇痛中的应用[J].广东医科大学学报,2014,32(3):353-354.
[16]魏旭东,王勇刚.地佐辛联合氟比洛芬酯对妇科腔镜术后疼痛及炎性细胞因子的影响[J].安徽医学,2014,35(11):1557-1559.
[17]Liu S,Carpenter RL,Neal JM. Epidural anesthesia and analgesia[J]. Anesthesiology,2016,82(6):1474-1506.
[18]Gorlin A W,Rosenfeld DM,Ramakrishna H. Intravenous sub-anesthetic ketamine for perioperative analgesia[J]. J Anaesthesiol Clin Pharmacol,2016,32(2):160-167.
[19]Albrecht E,Guyen O,Jacot-Guillarmod A,et al. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty:a systematic review and meta-analysis[J]. Br J Anaesth,2016,116(5):597-609.
[20]Sharar SR,Alamdari A,Hoffer C,et al. Circumplex model of affect:a measure of pleasure and arousal during virtual reality distraction analgesia[J]. Games Health J,2016,5(3):197-202.
[21]Wolf A,M?rgeli R,Müller A,et al. Delirium,analgesia,and sedation in intensive care medicine:Development of a protocol-based management approach[J]. Med Klin Intensivmed Notfmed,2017,112(1):65-74.
[22]Lin F,Xiao Y,Zan P,et al. Comparison of local infiltration analgesia with femoral nerve block for total knee arthroplasty:a prospective,randomized clinical trial[J]. J Arthroplasty,2016,31(6):1361-1365.
[2]朱剑宇,荚卫东,许戈良,等.帕瑞昔布钠联合芬太尼多模式镇痛对原发性肝癌患者围术期免疫功能的影响[J].中华普通外科杂志,2016,31(2):117-120.
[3]徐艳,杨文华,吴俊,等.地佐辛注射液对小儿全麻术后的镇痛研究[J].中国临床药理学杂志,2016,32(24):2253-2256.
[4]朱晓昌,支连军,王爽,等.氟比洛芬酯预防瑞芬太尼麻醉后的痛觉过敏[J].临床麻醉学杂志,2016,32(9):889-891.
[5]宋斌,蒋晧宇,闫鑫,等.靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究[J].新疆医科大学学报,2017,40(6):751-754.
[6]余理想,徐福涛,邱承忠.氟比洛芬酯联合地佐辛用于悬雍垂腭咽成形术术后静脉自控镇痛的效果[J].临床麻醉学杂志,2014,30(12):1205-1207.
[7]刘晓宇,段满林,王建华,等.地佐辛复合氟比洛芬酯用于上腹部手术术后镇痛的多中心临床研究[J].临床麻醉学杂志,2012,28(3):213-215.
[8]周斌福,瞿清,陈春丽.地佐辛复合氟比洛芬酯在脊柱后路手术术后镇痛中的效果[J].中国临床药理学与治疗学,2012,17(3):322-325.
[9]周萍.地佐辛联合氟比洛芬酯用于老年髋关节置换患者术后镇痛的临床研究[J].世界临床药物,2014,35(11):683-685,709.
[10]奚高原,孟睿,李青春,等.地佐辛复合氟比洛芬酯用于肺癌根治术术后镇痛的临床研究[J].医药论坛杂志,2014,36(6):154-156.
[11]张新科.地佐辛伍用氟比洛芬酯在开胸患者术后PCIA中的应用[J].中国医学工程,2014,22(12):104-105,108.
[12]徐守才,扈智多,陈红,等.不同自控静脉镇痛方案在开胸术后镇痛效果的观察[J].临床麻醉学杂志,2014,30(7):679-681.
[13]李冰,黄宁,王志刚,等.地佐辛联合氟比洛芬酯用于老年肿瘤患者开胸手术术后的镇痛效果[J].临床麻醉学杂志,2013,29(10):1007-1008.
[14]范海哲,张婧杰.不同剂量地佐辛复合氟比洛芬酯在下肢骨折手术术后镇痛的效果[J].临床麻醉学杂志,2014,30(10):1001-1004.
[15]谢峥嵘,孟宪慧,周俊辉.多模式镇痛在老年患者开胸手术后镇痛中的应用[J].广东医科大学学报,2014,32(3):353-354.
[16]魏旭东,王勇刚.地佐辛联合氟比洛芬酯对妇科腔镜术后疼痛及炎性细胞因子的影响[J].安徽医学,2014,35(11):1557-1559.
[17]Liu S,Carpenter RL,Neal JM. Epidural anesthesia and analgesia[J]. Anesthesiology,2016,82(6):1474-1506.
[18]Gorlin A W,Rosenfeld DM,Ramakrishna H. Intravenous sub-anesthetic ketamine for perioperative analgesia[J]. J Anaesthesiol Clin Pharmacol,2016,32(2):160-167.
[19]Albrecht E,Guyen O,Jacot-Guillarmod A,et al. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty:a systematic review and meta-analysis[J]. Br J Anaesth,2016,116(5):597-609.
[20]Sharar SR,Alamdari A,Hoffer C,et al. Circumplex model of affect:a measure of pleasure and arousal during virtual reality distraction analgesia[J]. Games Health J,2016,5(3):197-202.
[21]Wolf A,M?rgeli R,Müller A,et al. Delirium,analgesia,and sedation in intensive care medicine:Development of a protocol-based management approach[J]. Med Klin Intensivmed Notfmed,2017,112(1):65-74.
[22]Lin F,Xiao Y,Zan P,et al. Comparison of local infiltration analgesia with femoral nerve block for total knee arthroplasty:a prospective,randomized clinical trial[J]. J Arthroplasty,2016,31(6):1361-1365.