氢吗啡酮和舒芬太尼用于术后静脉自控镇痛比较的meta分析

Meta-analysis of comparison between hydromorphone and sufentanil in postoperative intravenous controlled analgesia

目的探讨氢吗啡酮和舒芬太尼在患者静脉自控镇痛的临床疗效。方法检索PubMed、Cochrane Library、中国生物医药、中国知网、万方、维普等数据库至2020年10月30日,收集氢吗啡酮和舒芬太尼用于患者静脉自控镇痛比较的文献,经文献筛选、资料提取及评价文献质量后,采用Revman 5.2软件进行统计学分析。结局指标包括术后疼痛评分、镇静评分、术后恶心呕吐、皮肤瘙痒和呼吸抑制发生率。结果总共纳入14篇研究,共1161名患者。结果显示:老年患者使用氢吗啡酮的术后镇痛效果优于舒芬太尼,差异有统计学意义(MD=-1.13,95%CI=-1.76~-0.50,P=0.0005),非老年患者使用氢吗啡酮或者舒芬太尼差别无统计学意义(MD=0.19,95%CI=-0.10~0.48,P=0.20)。与舒芬太尼相比,患者静脉自控镇痛使用氢吗啡酮的术后镇静程度、恶心呕吐及皮肤瘙痒发生率方面差异无统计学意义(MD=-0.16,95%CI=-0.47~0.15,P=0.31,OR=0.83,95%CI=0.53~1.30,P=0.42;OR=0.95,95%CI=0.45~2.04,P=0.9),但能降低呼吸抑制发生率,差别有统计学意义(OR=0.28,95%CI=0.11~0.72,P=0.008)。结论相比舒芬太尼,老年患者静脉自控镇痛使用氢吗啡酮在镇痛方面有一定优势,且能降低呼吸抑制发生率。

Objective To evaluate the patient controlled intravenous analgesia effect between hydromorphone and sufentanil.Methods PubMed,Cochrane Library,CBM,CNKI,Wanfang Database,and VIP Database(by October 30,2020)were searched for citations comparing hydromorphone and sufentanil for the patient controlled intravenous analgesia.After screening the citations,extracting data,and evaluating the quality,Revman 5.2 software was used for statistical data analysis.The outcomes included pain score,sedation score,the incidence of nausea and vomiting,itching,and respiratory depression during postoperative.Results A total of 14 studies involving 1161 patients were included.The results showed that the postoperative analgesic effect of hydromorphone was better than that of sufentanil in the elderly,with statistically significant difference(MD=-1.13,95%CI=-1.76--0.50,P=0.0005),and there was no difference in the younger(MD=0.19,95%CI=-0.10-0.48,P=0.20).Compared with sufentanil,PCIA with hydromorphone showed no significant difference in the incidence of postoperative sedation,nausea and vomiting,and itching(MD=-0.16,95%CI=-0.47-0.15,P=0.31,OR=0.83,95%CI=0.53-1.30,P=0.42;OR=0.95,95%CI=0.45-2.04,P=0.9),but lowered the incidence of respiratory depression,with statistically significant difference(OR=0.28,95%CI=0.11-0.72,P=0.008).Conclusion Compared with sufentanil,PCIA with hydromorphone has a better analgesic effect in the elderly,and reduce the incidence of respiratory depression.