地佐辛与曲马多术后镇痛效果及安全性的Meta分析

Efficacy and Safety of Injected Dezocine and Tramadol for Acute Postoperative Pain:A Meta-analysis

目的:系统评价地佐辛和曲马多用于术后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1999～2012年发表的关于地佐辛、曲马多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11个RCT,包括698例患者。Meta分析结果显示:①有效性:术中静注地佐辛镇痛,术后疼痛评分VAS 2 h、3 h、4 h评分均明显低于曲马多组[RR(95%CI)分别-0.95(-1.21,-0.69),-0.87(-1.41,-0.32),-1.04(-1.66,-0.43)],但是VAS30 min、VAS 1 h、VAS 12 h、VAS 24 h、VAS 48 h及Ramsay 1 h、Ramsay 4 h两组之间无统计学差异;②安全性:术后清醒时间、呼吸恢复时间以及术后呼吸抑制、头晕、皮肤瘙痒发生率两者无差异。但是恶心呕吐发生率方面地佐辛组明显低于曲马多组[RR(95%CI)0.15(0.07,0.29)]。结论:与曲马多相比,术中给予地佐辛能明显降低患者的术后急性期疼痛程度,且术后恶心呕吐发生率明显下降。

Objective： To systematically evaluate the efficacy and safety of injected dezocine and tramadol for postoperative pain. Methods： Data were electronically searched in the PubMed, EBSCO, Springer, Ovid and CNKI databases from 1999 to Jan. 2012 to identify randomized controlled trials （RCTs） about dezocine and tramadol for postoperative pain. The methodological qualities of included RCTs were assessed, and the data was extracted by two reviewers independently. The homogeneous RCTs were evaluated using the RevMan software, and the non-homogeneous studies evaluated using descriptive qualitative analysis. Results： Eleven RCTs involving 698 patients met the inclusion criteria. The results of meta-analyses showed that： ①Efficacy： The VAS scores were significantly lower within postoperative 2, 3 and 4 hours in the dezocine group than those in the tramadol group [RR （95% CI） were -0.95（-1.21, -0.69）, -0.87（-1.41, -0.32） and -1.04 （-1.66, -0.43）, respectively], but there was no significant difference with the VAS at 30 rain, 1 h, 12 h, 24 or 48 h, or with Ramsay at I or 4 h; ②Safety： there was no significant difference between the two groups in wake time, respiratory recovery time, breath depress, diziness or skin itching after surgery, but the incidence of nausea and vomiting in dezocine group was lower than that in tramadol group [RR（95% CI） 0.15 （0.07, 0.29）]. Conclusion： Compared with tramadol, dezocine injected during the operation can significantly decrease the scores of acute pain with lower incidence of postoperative nausea and vomiting.