地佐辛联合舒芬太尼用于全麻术后患者静脉自控镇痛的临床效果及安全性：Meta分析

Dezocine combined with sufentanil versus sufentanil for postoperative patient-controlled intravenous analgesia： a systematic review

目的系统评价地佐辛联合舒芬太尼与单独舒芬太尼用于术后患者自控静脉镇痛（patient controlled intravenous analgesia, PCIA）的临床效果及副作用。方法计算机检索Cochrane Library、PubMed、Embase、CBM、Ovid、Science Direct、ProQuest、Springer、CNKI、万方和维普等数据库从建库至2014年6月文献，在按纳入和排除标准进行资料提取和文献质量评价后，采用RevMan5．1版软件进行Meta分析。结果共纳入6个随机对照实验，共计患者477例。Meta分析结果显示：地佐辛联合舒芬太尼与单独舒芬太尼分别用于PCIA后，患者术后4、8、12、24h视觉模拟评分（visualanaloguescales，VAS）比较，差异无统计学意义（P〉0．05），术后48hVAS[加权均数差（weighted mean difference，WMD）=-0．36，95％置信区间（confidence interval，C／）（-0．69，-0．04）]差异有统计学意义（P〈0．05）；副作用总发生率差异有统计学意义[比值比（oddsratio，OR）=0．36，95％CI（0．26，0．50）]（P〈0．05）；术后24、48h白细胞介素（interleukin，IL）-6及IL-10水平差异有统计学意义（P〈0．05）。结论地佐辛联合舒芬太尼镇痛效果明显且副作用少，能在一定程度上改善免疫功能。

Objective To evaluate the clinical efficacy and adverse effect of a combination of and sufentanil versus sufentanil for postoperative patient-controlled intravenous analgesia （PCIA）. Methods The relevant randomized controlled trials were searched in the Cochrane Library, PubMed, Embase, CBM, Ovid, SeienceDirect, ProQuest, Springer, CNKI, WanFang Data and VIP databases （updated to June 2014）. The quality of the included studies was evaluated after data extraction according to the inclusion and exclusion criteria by two reviewers independently. The Meta-analysis was performed by using RevMan 5.1 software. Results Six trials with a total of 477 patients were included. The results showed that there were no significant differences of visual analog scale（VAS） at 4,8,12 h, and 24 h between groups（P〉0.05）. However the VAS at 48 h was decreased in dezocine combined with sufentanil group [ weighted mean difference （ WMD ） =-0.36,95% confidence interval （CI） （ -0.69, -0.04 ） ] （P〈0.05）. There were significant differences in adverse effects [ odds ratio （ OR ） =0.36,95% CI （0.26,0.50） ] （P〈0.05）. There were significant differences of interleukin （IL）-6 and IL-10 at 24 h and 48 h postoperatively （P〈0.05）. Conclusions Dezocine combined with sufentanil provide sufficient analgesia effect but with fewer adverse effects and seemed to improve the systematic immune function for postoperative patient-controlled intravenous analgesia.