舒芬太尼与芬太尼术后皮下自控镇痛的系统评价

Sufentanil versus Fentanyl for Post-Operation Patient-Controlled Subcutaneous Analgesia: A Systematic Review and Meta-Analysis

目的系统评价舒芬太尼与芬太尼用于患者术后皮下自控镇痛的镇痛效果和不良反应,为临床合理用药提供依据。方法计算机检索MEDLINE(1976-2012年)、Cochrane图书馆、PubMed(1976-2012年)、EMBASE(1976-2012年)、中国生物医学文献数据库、CNKI、VIP、万方等数据库;手工检索图书馆馆藏期刊,收集舒芬太尼与芬太尼用于术后皮下自控镇痛的随机对照试验,并根据Cochrane系统评价员手册5.0版本进行质量评价,采用RevMan 5.1软件进行Meta分析。结果共纳入5个随机对照试验,合计293例患者。Meta分析结果显示:①疼痛视觉模拟评分:芬太尼组与舒芬太尼组术后4 h[加权均数差=-0.11,95%可信区间(-0.35,0.14),P=0.39]、8 h[加权均数差=-0.11,95%可信区间(-0.54,0.31),P=0.60]、12 h[加权均数差=-0.32,95%可信区间(-0.97,0.33),P=0.33]和24 h[加权均数差=-0.24,95%可信区间(-0.88,0.39),P=0.45]均无差异;而与芬太尼组相比,舒芬太尼组术后48 h疼痛视觉模拟评分降低[加权均数差=-0.49,95%可信区间(-0.75,-0.22),P=0.000 3]。②不良反应:舒芬太尼组和芬太尼组患者恶心、呕吐和头晕嗜睡的发生率无明显差异[相对危险度=0.20,95%可信区间(0.02,1.64),P=0.13;相对危险度=0.33,95%可信区间(0.04,3.08),P=0.33]。结论芬太尼和舒芬太尼均适用于皮下自控镇痛,但舒芬太尼更适合用于长期需要镇痛的患者。

Objective To investigate the efficacy and the incidence of side effects of Sufentanil and Fentanyl for post-operation patient-controlled subcutaneous analgesia （PCSA）. Methods Databases including MEDLINE, the Cochrane Library, PubMed, EMBASE, CBMDisc, CNKI, VIP, Wanfang data were searched. Randomized controlled trials （RCTs） of sufentanil versus Fentanyl for post-operation PCSA were included. The quality of the trials was critically assessed according to the Cochrane Handbook 5.0. RevMan 5.1 software was used for meta-analysis. Results 5 trials including 293 patients were analyzed. The results of recta-analysis showed that： ① Visual analog scale （VAS）： There were no significant differences at 4 h[WMD=-0.11, 95%CI（-0.35, 0.14）, P=0.391, 8 h[WMD=-0.11, 95%CI （-0.54,0.31）, P=0.60], 12 h[WMD=-0.32, 95%CI（-0.97, 0.33）, P=0.33] and 24 h[WMD=-0.24, 95%CI （-0.88, 0.39）, P=0.45] between the two groups. But the VAS at 48 h[WMD=-0.49, 95%CI （-0.75, -0.22）, P=0.000 3 ] was decreased in Sufentanil group. ② Side effects： There were no significant differences in the side effects of nausea, vomiting and dizziness between the two groups [RR=0.20, 95%CI（0.02, 1.64）, P=0.13; RR=0,33, 95%CI （0.04,3.08）, P=0.33]. Conclusion Both Fentanyl and Sufentanil are used for PCSA, but Sufentanil is more suitable for patients in needs of long-term analgesic.