不同干预措施预防罗库溴铵注射相关疼痛/缩肢反应有效性的Meta分析

Efficacy of Different Interventions in Preventing Rocuronium-induced Injection Pain or Withdrawal Movements:A Meta-analysis

目的系统评价不同干预措施用于预防罗库溴铵注射相关疼痛/缩肢反应的有效性,为临床预防罗库溴铵注射相关的不良反应提供参考依据。方法计算机检索PubMed、EMbase、The Cochrane Library(2014年3期)、WanFang Data、CBM和CNKI数据库,搜集有关不同干预方式用于预防罗库溴铵注射相关疼痛/缩肢反应的随机对照试验(RCT),检索时限均为建库至2014年3月。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.2.8软件进行Meta分析。结果共纳入43个RCT,6 034例患者。Meta分析结果显示,与安慰剂/空白对照比较,采用静脉阻断法注射利多卡因[RR=0.37,95%CI(0.29,0.48),P<0.000 01]、静脉阻断法注射阿片类药物[RR=0.77,95%CI(0.68,0.87),P<0.000 1]、静脉注射利多卡因[RR=0.51,95%CI(0.44,0.59),P<0.000 01]、静脉注射阿片类药物[OR=0.03,95%CI(0.02,0.05),P<0.000 01]、静脉注射氯胺酮[RR=0.36,95%CI(0.23,0.54),P<0.000 01]、罗库溴铵与碳酸氢钠混合注射[OR=0.02,95%CI(0.01,0.04),P<0.000 01],以及局部加温法[RR=0.74,95%CI(0.63,0.88),P=0.000 6]均可预防罗库溴铵注射疼痛/缩肢反应的发生。结论静脉注射阿片类药物是预防罗库溴铵注射相关疼痛/缩肢反应的有效措施,而局部加温法的相关研究较少,结果存在偏倚的可能性较大。受纳入研究数量和质量的限制,上述结论尚需要更多高质量研究予以验证。

Objective To systematically evaluate the efficacy of different interventions in preventing rocuroniuminduced injection pain or withdrawal movements,so as to provide references for preventing adverse reactions induced by rocuronium injection in clinical practice.Methods We electronically searched PubMed,EMbase,The Cochrane Library（Issue 3,2014）,CBM,and CNKI databases to collect randomized controlled trials（RCTs） about the prevention of rocuronium-induced injection pain or withdrawal movements from inception to March 2014.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Then,meta-analysis was performed using RevMan 5.2.8 software.Results A total of 43 RCTs involving 6 034 patients were include.The results of meta-analysis showed that compared with the placebo/blank group,lidocaine pretreatment with venous occlusion（RR=0.37,95%CI 0.29 to 0.48,P0.000 01）,opioid drug pretreatment with venous occlusion（RR=0.77,95%CI 0.68 to 0.87,P0.000 1）,lidocaine pretreatment with venous injection（RR=0.51,95%CI 0.44 to 0.59,P0.000 01）,opioid drug pretreatment with venous injection（OR=0.03,95%CI 0.02 to 0.05,P0.000 01）,ketamine pretreatment with venous injection（RR=0.36,95%CI 0.23 to0.54,P0.000 01）,mixing sodium bicarbonate（NaHCO3） with rocuronium（OR=0.02,95%CI 0.01 to 0.04,P0.000 01） and local heating（RR=0.74,95%CI 0.63 to 0.88,P=0.000 6） were all effective in decreasing the incidence of rocuronium-induced injection pain or withdrawal movements.Conclusion The intravenous injection of opioid drugs was effective in preventing rocuronium-induced injection pain or withdrawal movements,while local heating needs further research.Due to the limited quantity and quality of the induced studies,the above conclusion still needs to be verified by more high quality studies.