硬膜外镇痛和静脉镇痛对脊柱融合术后镇痛效果比较的Meta分析

Comparison of the analgesic efficacy between the epidural and intravenous analgesia after spinal fusion: a Meta-analysis

中文关键词:  硬膜外镇痛  静脉镇痛  脊柱融合  随机对照试验  Meta分析

英文关键词:Epidural analgesia  Intravenous analgesia  Spinal fusion  Randomized controlled trial  Meta-analysis

中文摘要:

  【摘要】 目的：采用Meta分析方法比较硬膜外镇痛和静脉镇痛两种自控镇痛方式对脊柱融合术后的镇痛效果。方法：计算机检索中国知网、万方数据库、中国生物医学文献数据库（CBM）、Pubmed、Embase、Ovid、Cochrane Library数据库，收集发表于1985年5月~2013年7月在接受脊柱融合术后行硬膜外镇痛和静脉镇痛的随机对照试验的文献，并追溯纳入文献的参考文献后，按Cochrane系统评价员手册5.1.0对纳入文献进行质量评价，对纳入文献的术后VAS评分和使用镇痛药物后的不良反应发生率提取整理成电子基线表，通过RevMan 5.2软件进行Meta分析。结果：共纳入8篇文献，包括482例患者，其中3篇文献质量等级为A级，5篇为B级。Meta分析结果显示：①术后第1、2天VAS评分分析[加权均数差值（WMD）=－0.47，95%CI（－0.74，－0.20）；WMD=－0.66，95%CI（－1.14，－0.19）]，硬膜外镇痛较静脉镇痛的镇痛效果好（P<0.05）；术后第3天VAS评分[WMD=－0.58，95%CI（－1.38，0.21）]两组差异无统计学意义（P>0.05）。②不良反应：硬膜外镇痛在术后皮肤瘙痒[相对危险度（RR）=1.53，95%CI（1.08，2.16）]、感觉异常[RR=3.34，95%CI（1.12，9.98）] 的发生率较静脉镇痛高，差异有统计学意义（P<0.05）；但在恶心[RR=1.05，95%CI（0.79，1.40）]、呕吐[RR=0.80，95%CI（0.48，1.31）]方面差异无统计学意义（P>0.05）。结论：脊柱融合术后第1、2天硬膜外镇痛的镇痛效果较静脉镇痛好，但皮肤瘙痒、感觉异常的发生率也明显高于静脉镇痛。

英文摘要:

  【Abstract】 Objectives: To compare the efficacy of patient-controlled epidural analgesia and patient-controlled intravenous analgesia in postoperative analgesia after spinal fusion. Methods: The CNKI, Wanfang, CBM,Pubmed, Embase, Ovid, Cochrane library databases were searched by computer. The randomized controlled trails with patient-controlled epidural analgesia or patient-controlled intravenous analgesia after spinal fusion published from May 1985 to July 2013 were selected. All of them were assessed by the standard of Cochrane systematic review. Data of postoperative VAS and the rate of side effects after using the analgesic drugs were extracted into an electrical sheet, which was synthesized by a Meta-analysis with RevMan 5.2 software. Result: Eight randomized controlled trails involving 482 patients met the inclusion criteria. And the quality grade of 3 literatures was A, 5 literatures was B. The result of meta-analysis showed that: ①Visual analogue score(VAS). The postoperative first day′s VAS[WMD=－0.47, 95%CI(－0.74, －0.20)], second day′s VAS[WMD= －0.66, 95%CI(－1.14, －0.19)] showed that the patient-controlled epidural analgesia had a good analgesic effect compared with the patient-controlled intravenous analgesia, and both had statistic differences(P<0.05). No difference in the postoperative third day′s VAS[WMD=－0.58, 95%CI(－1.38, 0.21)] was observed between the two methods, and no statistic difference(P>0.05); ②The side effects. The patient-controlled epidural analgesia had a higher incidence of skin itch[RR=1.53, 95%CI(1.08, 2.16)], paresthesia[RR=3.34, 95%CI(1.12, 9.98)] after surgery than the patient-controlled intravenous analgesia, and both had statistic differences(P<0.05). While two groups had no a significant deviation about nausea[RR=1.05, 95%CI(0.79, 1.40)], vomiting[RR=0.80, 95%CI(0.48, 1.31)], and no statistic difference(P>0.05). Conclusions: The patient-controlled epidural analgesia has better analgesic effects on the postoperative first and second day after spinal fusion, but obviously has a higher incidence of skin itch and paresthesia than the patient-controlled intravenous analgesia.