曲马多联合布托啡诺术后静脉自控镇痛的meta分析

A meta analysis of tramadol combined with butorphanol for PCIA

目的系统评价曲马多联合布托啡诺用于术后静脉自控镇痛(PCIA)的临床疗效与安全性,为临床合理用药提供循证医学依据。方法计算机检索PubMed、Embase、Cochrane图书馆、CNKI、VIP等数据库,纳入曲马多联合布托啡诺用于术后PCIA的临床研究文献,采用RevMan 5.0软件进行meta分析。结果共纳入5个随机对照试验(RCT),共332例患者,meta分析结果显示:①视觉模拟评分法(VAS)评分:联合用药组术后4、24、48 h时间点VAS均低于单用曲马多组;与单用布托啡诺组比较,各时间点VAS差异无统计学意义。②镇静评分:联合用组术后4、8、24、48 h评分差异无统计学意义。③不良反应:联合用药组恶心呕吐、眩晕、嗜睡、尿潴留等不良反应发生率显著降低。结论现有证据表明,曲马多联合布托啡诺与单用曲马多或布托啡诺PCIA均能获得满意的镇痛效果,但联合用药能降低不良反应的发生率。

[ Objective ] To evaluate the effectiveness and adverse reaction of tramadol combine with butorphanol for patient controlled intravenous analgesia （ PCIA ） , so as to provide evidence for rational drug use in clinic. [ Methods ] The randomized controlled trials of tramadol combined with butorphanol for PCIA were gathered from PubMed, Embase, and Coehrane database of Systematic Reviews, CNKI and VIP. The meta analysis was performed with The Cochrane Collaboration＇ s software RevMan 50. [ Results] Five randomized controlled trials （RCTs） were included, with a total of 332 cases, the meta analysis results showed： ① As for visual analog scale （VAS） score, compared with the tramadol group, the postoperative YAS at 4 hour, 24 hour and 48 hour was decreased in the combined drug group; but there were no significant differences compared with butorphanol group. ② Sedation Scale： there was no significant difference at 4 hour, 8hour, 24hour and 48 hour. ③Adverse reaction： the combination group compared with the single drug group, nausea, vomiting, dizziness, drowsiness, urinary retention incidence of adverse reactions was significantly reduced. [ Conclusion ] According to the available evidence, tramado[ combined with butorphanol for PCA can effectively alleviate postoperation pain, compared with tramadol or butorphanol, and the combination can reduce the incidence of adverse reactions