硬膜外镇痛对肠道手术预后影响的Meta分析

Effects of Epidural Analgesia on Prognosis after Intestinal Surgery:A Meta-analysis

目的系统评价硬膜外镇痛对肠道手术预后的影响。方法计算机检索PubMed、EBSCO、Springer、Ovid、CNKI和CBM数据库,纳入1985～2010年间发表的关于肠道手术应用硬膜外镇痛对术后胃肠功能影响的随机对照试验(RCT),按Cochrane系统评价方法对纳入文献进行资料提取和质量评价,而后采用RevMan5.0软件进行Meta分析。结果共纳入10个RCT,包括506例患者。纳入RCT质量均为C级。Meta分析结果显示:硬膜外自控镇痛与传统静脉自控镇痛相比,术后首次排气、首次排便和住院时间均缩短[MD(95%CI)分别为-1.07(-1.63,-0.50)、-0.63(-1.19,-0.08)和-1.36(-2.28,-0.44)]。术后第1和第2天呕吐发生率降低[OR(95%CI)分别为0.33(0.13,0.82)和0.32(0.13,0.84)]。术后第1、2和3天静息痛VAS[MD(95%CI)分别为-26.60(-33.06,-20.15)、-25.98(-30.98,-20.97)和-15.59(-27.29,-3.88)],运动痛VAS[MD(95%CI)分别为-26.00(-36.00,-16.00)、-27.89(-35.70,-20.08)和-11.79(-21.28,-2.30)]均明显降低。而在术后尿道感染、尿潴留、吻合口漏和肠梗阻发生率方面,两者间差异无统计学意义。结论肠道手术术后应用硬膜外自控镇痛较之传统静脉自控镇痛能明显缩短首次排气、排便和术后住院时间,且能明显降低术后疼痛VAS,降低术后呕吐发生率。但本研究纳入RCT质量均低,样本量小,结论尚需大规模高质量RCT证实。

Objective To systematically evaluate the effect of epidural analgesia on prognosis after intestinal surgery.Methods Such databases as PubMed,EBSCO,Springer,Ovid and CNKI were searched to identify randomized controlled trials（RCTs） about the effects of epidural analgesia on prognosis after intestinal surgery published from 1985 to 2010.The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Handbook,and then the meta-analyses were conducted by using RevMan 5.0 software.Results Ten RCTs involving 506 patients were included.The results of meta-analyses showed that compared with the patient controlled analgesia（PCA）,the patient controlled epidural analgesia（PCEA） significantly reduced the waiting time for having first flatus,first defecation,and the length of hospital stay（MD=-1.07,95%CI-1.63 to-0.50;MD=-0.63,95%CI-1.19 to-0.08;MD=-1.36,95%CI-2.28 to-0.44;respectively）,lowered the frequency of vomiting on the first and second day after operation（OR=0.33,95%CI 0.13 to 0.82;OR=0.3,95%CI 0.13 to 0.84;respectively）,and obviously declined the visual analog scale（VAS） scores of rest pain on the first,second and third day after operation（MD=-26.60,95%CI-33.06 to-20.15;MD=-25.98,95%CI-30.98 to-20.97;MD=-15.59,95%CI-27.29 to-3.88;respectively）,and the VAS scores of motion pain on the first,second and third day after operation（MD=-26.00,95%CI-36.00 to-16.00;MD=-27.89,95%CI-35.70 to-20.08;MD=-11.79,95%CI-21.28 to-2.30;respectively）.There were no significant differences between the two groups in the incidence of urinary tract infection,urinary retention,anastomotic leak and ileus.Conclusion PCEA significantly reduces the waiting time for having first flatus and first feces,the length of hospital stay,the VAS scores of pain,and the incidence of postoperative vomiting.