单剂量非麻醉性镇痛药预防瑞芬太尼麻醉后痛觉过敏的有效性Meta分析

Clinical effect of single-dose of intravenous non-narcotic analgesics for prevention of hyperalgesia after remifentanil-based anesthesia: a Meta-analysis

目的:评价非麻醉性镇痛药(氯胺酮、帕瑞昔布钠、氟比洛芬酯)预防瑞芬太尼麻醉后疼痛过敏的有效性。方法:电子检索Pubmed,EBSCO,Springer,Ovid,CNKI等数据库,收集发表于1990-2011年的非麻醉性镇痛药物预防瑞芬太尼麻醉后疼痛过敏的临床试验性文章及相关的参考文献,按Cochrane系统评价方法对纳入的文献进行质量评价和资料提取。统计学分析采用RavMan 5.0软件。结果:共纳入24篇随机对照试验,包括1 525例患者。Meta分析显示:疼痛评分[拔管后口述疼痛评分(VRS)和停药后24 h内视觉疼痛模拟评分(VAS)]:单剂量静注氯胺酮可显著降低患者VRS和停药后1,2和4 h的VAS评分(P<0.01),静注帕瑞昔布纳可显著降低患者停药后8 h的VAS评分(P<0.01);静注氟比洛芬酯能够显著降低患者VRS和停药后1,2,4,6和8 h的VAS评分(P<0.01);其余各观察点VAS评分较对照组无明显差别。停药后清醒时间、拔管时间和再次要求镇痛的人数:单剂量静注氯胺酮、帕瑞昔布纳、氟比洛芬酯不延迟患者清醒和拔管时间,且能明显减少停药后追加其他镇痛药物的人数(P<0.01)。停药后不良反应发生率:除氯胺酮能明显患者降低停药后躁动的发生率外(P<0.01),三者对预防术后头疼、恶心、呕吐等不良反应无统计学差异。结论:单剂量静注氯胺酮、帕瑞昔布纳、氟比洛芬酯可有效预防瑞芬太尼麻醉后诱发的疼痛过敏,减少停药后再次要求镇痛的人数。

Objective ： The evidence for using single-dose of non-narcotic analgesics to prevent hyperalgesia after remifentanil-based anesthesia was examined by conducting a meta-analysis. Methods： A literature search for articles describing clinical effects of non-narcotic analgesics （ ketami＇ne, parecoxib sodium and flurbiprofen axetil） was conducted using computerized database Pubmed, EBSCO, Springer, Ovid and CNKI from the year 1990 to 2011. The references listed in the found articles were also checked. The qualities of all included articles were as- sessed and data was extracted by the standard of Cochrane systematic review. The homogeneous research was ana- lyzed by RevMan5.0 software, while the non-homogeneous research was analyzed by descriptive analysis method. Results： Twenty-four articles involving a total of 1 525 patients met the inclusion criteria. Meta-analysis showed that Verbal rating scale （VRS） after extubation and visual analogue scale （VAS） within 24-hour after remifentanilwithdrawal were as follows： patients receiving single-dose of intravenous ketamine had significantly lower VRS and VAS scores at 1, 2, 4 h（ P 〈 0.01 ） ; single-dose of intravenous flurbiprofen axetil significantly decreased the VRS and VAS scores at 1, 2, 4, 6, 8 h（P 〈 0.01 ） ; while a single-dose of intravenous parecoxib sodium decreased the VAS scores at 8 h（P 〈0.01 ） ; there was no obvious difference in VAS scores at other observation time points after remifentanil withdrawal. Ketamine, parecoxib sodium and flurbiprofen axetil had no significant effects on recovery time and extubation time, but significantly reduced the number of patients requiring rescue medication （P 〈 0.01 ）. There was no statistically significant difference among the three analgesics inthe prevention of postoperative side effects such as headache, nausea and vomiting after remifentanil withdrawal, except that ketamine significantly de- creased the incidence of postoperative restlessness （P 〈 0.01 ）. Conclusion ： Single-dose of non-narcotic analgesics can significantly prevent postoperative hyperalgesia after remifentanil-based anesthesia and reduce the number of pa- tient requiring rescue medication.