NMDA受体拮抗剂预防瑞芬太尼诱发术后痛觉过敏的效果：Meta分析

Preventive efficacy of NMDA receptor antagonists on remifentanil-induced postoperative hyperalgesia： a Meta-analysis

目的采用Meta分析评价N-甲基-D-天冬氨酸（NMDA）受体拮抗剂预防瑞芬太尼诱发术后痛觉过敏的效果。方法检索PubMed、EMBase、Springer及Cochrane图书馆，收集NMDA受体拮抗剂预防瑞芬太尼诱发术后痛觉过敏的临床随机对照研究。采用Cochrane协作网系统评价文献质量，并提取有关资料，主要包括术后镇痛药需要量、疼痛评分、手术结束至第1次需要镇痛治疗的时间以及术后不良反应的发生情况。采用RevMan5．0软件进行Meta分析。结果共纳入14项研究，包括623例患者，其中氯胺酮组223例，硫酸镁组87例，对照组313例。NMDA受体拮抗剂可降低术后4h时疼痛评分（P〈0．05），对术后镇痛药需要量、第1次需要镇痛治疗的时间及不良反应的发生率无影响（P〉0．05）。结论NMDA受体拮抗剂（氯胺酮和硫酸镁）不能预防瑞芬太尼诱发的术后痛觉过敏。

Objective To systematically review the preventive efficacy of N-methyl-D-aspartate （NMDA） receptor antagonists on remifentanil-indnced postoperative hyperalgesia. Methods Pubmed, EMBase, Springer and Cochrane Controlled Trials Register were searched to identify all randomized controlled trials（RCTs） about efficacy of NMDA receptor antagonists for preventing remifentanil-induced postoperative hypcralgesia. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. The data was extracted, including postoperative analgesic consumption, pain scores, time for first analgesic request and the incidence of adverse effects. Meta-analysis was conducted using the Cochranc Collaboration＇s RevMan 5.0 software. Results Fourteen RCTs involving 623 patients were included in our Meta-analysis. NMDA receptor antagonists significantly decreased pain scores at 4 h after operation （ P〈0.05）, and had no effect on postoperative analgesic consumption, time for first analgesic request and the incidence of adverse effects （ P〉0.05 ）. Conclusion NMDA receptor antagonists （ketamine and magnesium）can not prevent the occurrence of postoperative hyperalgesia induced by remifentanil.