帕瑞昔布术后临床镇痛效果和安全性的Meta分析

Efficacy and Safety of Injected Parecoxib Sodium for Acute Postoperative Pain:A Meta-analysis

目的系统评价帕瑞昔布用于术后临床镇痛的效果及安全性。方法电子检索PubMed、EBSCO、Springer、Ovid、CNKI等数据库,收集1999～2009年发表的关于患者自控镇痛(PCA)联合帕瑞昔布术后镇痛的随机对照试验(RCT),按Cochrane系统评价的方法评价纳入研究的质量和提取资料,并采用RevMan软件进行统计分析。结果共纳入7个RCT,包括1939例患者。Meta分析结果显示:①有效性:PCA联合术后短期静注帕瑞昔布镇痛,初始给药后24、48和72h,患者对镇痛效果满意度评分"有效"率均高于单用PCA[RR(95%CI)分别为1.41(1.13,1.75),1.25(1.15,1.35),1.30(1.21,1.40)],"无效"率均低于单用PCA[RR(95%CI)分别为0.43(0.26,0.72),0.44(0.34,0.57),0.33(0.23,0.48)]。②安全性:PCA联合帕瑞昔布能减少患者术后发热[RR=0.34,95%CI(0.22,0.53)]、恶心呕吐[RR=0.69,95%CI(0.57,0.83)]的发生率,但在减少患者呼吸抑制[RR=0.84,95%CI(0.38,1.83)]、瘙痒症[RR=0.91,95%CI(0.54,1.52)]、头疼[RR=0.77,95%CI(0.47,1.28)]方面与单用PCA的差异无统计学意义。结论PCA联合术后短期静注帕瑞昔布能明显提高患者对术后镇痛的满意程度,且不增加阿片类药物的不良反应,并可减少术后发热及恶心呕吐。

Objective To systematically evaluate the efficacy and safety of injected cyclooxygenase-2 inhibitor for acute postoperative pain. Methods We electronically searched PubMed, EBSCO, Springer, Ovid and CNKI databases from 1999 through Jan. 2009 to identify randomized controlled trials （RCTs） about cyclooxygenase-2 inhibitor or parecoxib sodium for acute postoperative pain. The methodological quality of included RCTs were assessed, and the data was extracted by two reviewers independently according to the Cochrane Handbook. The homogeneous RCTs were pooled using RevMan software, and the non-homogeneous studies evaluted using descriptive qualitative analysis. Results Seven RCTs involving 1939 patients met the inclusion criteria. The results of meta-analyses showed that： （1） Efficacy： The comparison of PCA combined parecoxib sodium （successively injected less than 3 days） i.v. with PCA alone： after 24, 48, and 72 hours of the initial dose of parecoxib 40 mg i.v., the percentage of the patients＇ global evaluation of study medication （PGESM） described effective （excellent and good） was higher than that of the control group [RR （95%CI） were 1.41 （1.13, 1.75）, 1.25 （1.15, 1.35）, and 1.30 （1.21, 1.40） respectively]; the percentage of the PGESM described ineffective （fair and poor） was lower than that of the control group [RR （95%CI） were 0.43 （0.26, 0.72）, 0.44 （0.34, 0.57）, and 0.33 （0.23, 0.48） respectively]. （2） Safety：. Combination of PCA with parecoxib sodium could lessen the incidence of postoperative fever （RR=0.34, 95%CI 0.22 to 0.53） and nausea and vomiting （RR=0.69, 95%CI 0.57 to 0.83）, but not statistically decrease of respiratory depression （RR=0.84, 95%CI 0.38 to 1.83）, pruritus （RR=0.91, 95%CI 0.54 to 1.52）, and headache （RR=0.77, 95%CI 0.47 to 1.28）. Conclusion The combination of PCA with parecoxib sodium successively injected less than 3 days can significantly increase the scores of PGESM, and does not increase the incidence of adverse effects or postoperative complications, and also has the advantage of decreasing postoperative fever, nausea and vomiting.