早期镇痛对急腹症诊疗影响的Meta分析

The effect of the early analgesia on the accuracy of the diagnosis and treatment of acute abdominal disease:A Meta-analysis

目的:探讨早期镇痛对急腹症诊疗准确性的影响。方法:计算机检索Pubmed、Embase、Cochrane database、CBM、CNKI、万方数据库,查找所有关于早期镇痛对急腹症诊治影响的随机对照实验(RCT),检索时限为建库至2013-09-30。按纳入排除标准再由两人独立进行RCT筛选、资料提取及质量评价。最后再应用RevMan5.2软件进行Meta分析。结果:在急腹症的腹部体格检查上,纳入7个随机对照研究,镇痛组381名患者,对照组350名患者,结果显示应用镇痛药并没有增加腹部体格检查的风险性,其相对危险度(RR)为0.90[95%CI(0.80,1.02)]。在急腹症疾病诊断的敏感性上,纳入9个随机对照研究,镇痛组574名患者,对照组520名患者,结果同样显示应用镇痛药没有增加诊断准确性的风险性,其RR为1.03[95%CI(0.90,1.08)]。结论:早期镇痛对于急腹症的体格检查及疾病的诊疗上并没有显著的影响。

Objective：To objectively evaluate the effect of the early analgesia on the accuracy of the diagnosis and treatment of acute abdominal disease.Method：Such database as Pubmed,Embase,the Cochrane database,CBM,CNKI and wanfang were searched from their establishment to September 30,2013 for collecting the randomized controlled trials（RCT）of all about early analgesia effect on diagnosis and treatment of acute abdominal pain.After study selection,data extraction and quality evaluation by two reviewers independently.Finally,RevMan 5.2software was used for Meta analysis.Result：Seven studys about physical examination of acute abdominal pain involving 381 patients in the analgesia group and 350 patients in the control group were included.It was not showed trends toward increased risks of altered finding on the abdominal examination due to early analgesia,with risk ratios changes in the physical examination of 0.90（95% CI 0.80 to 1.02）.Nine studys about the diagnosis sensitivity of acute abdominal disease,involving 574 patients in the analgesia group and 520 patients in the control group were included.It was also not showed trends toward increased risks of altered finding on the accuracy of the diagnosis due to early analgesia,with risk ratios changes in the diagnosis sensitivity of 1.03（95%CI 0.98 to 1.08）.Conclusion：The current evidence indicates that early analgesia has no significant effect on the physical examination and diagnosis sensitivity of acute abdominal disease.