髋关节置换术后硬膜外和静脉自控镇痛效果的系统评价

Effects of patient controlled epidural analgesia and patient controlled intravenous analgesia after hip replacement:A systematic review

目的系统评价髋关节置换术后经硬膜外与经静脉自控镇痛的效果和不良反应。方法根据Cochrane系统评价方法 ,计算机检索Cochrane Library、OVID、EMbase、PubMed、CNKI、VIP、CBM等数据库,收集相关的随机对照试验(RCT),同时筛检纳入文献的参考文献,评价其方法学质量,并采用RevMan5.0进行Meta分析。结果共纳入8个RCT,包括435例患者。按镇痛方法和测量指标进行亚组分析,Meta分析结果显示:术后硬膜外自控镇痛(PCEA)4、12、24、48h的镇痛效果均优于静脉自控镇痛(PCIA),住院时间短于PCIA;恶心、呕吐、低血压等术后不良反应的发生率与PCIA比较差异均无统计学意义(P>0.05)。结论 PCEA的镇痛效果、康复速度和总体满意度均优于PCIA。但本系统评价纳入研究病例数有限,且偏倚情况不确定,尚期待开展更多设计严谨的大样本、多中心随机对照试验加以验证。

Objective To evaluate the efficacy and adverse effect of patient controlled epidural analgesia （ PCEA ） and patient controlled intravenous analgesia （ PCIA ） after hip replacement. Methods According to the Coehrane Handbook, we searched database like Cochrane Library, OVID, EMbase, PubMed, CNKI, VIP and CBM to collect related randomized controlled trials （ RCT）. The quality of the included studies was evaluated and was analyzed by meta-analysis with RevMan 5.0. Results Eight RCTs involving 435 participants were included. Meta-analysis results ： ①The effect of PCEA was better than that of PCIA in 4, 12, 24 and 48 hours after operation; The discharge time of the patients with PCEA is earlier than those with PCIA ; ②No significant differences were observed in nausea, vomiting, hypotension and other side effects between PCEA and PCIA. Conclusion PCEA is a more effective and safer postoperative analgesia technique than PCIA ＇in patients undergoing hip replacement. But a 10t of larger sample, multiple-center and randomized controlled trials are needed to provide more evidence to support our outcome.