N-甲基D-天冬氨酸受体拮抗剂预防瑞芬太尼诱发痛觉过敏的Meta分析

Meta-analysis on the effect of N-methyl-D-aspartate receptor antagonist on remifentanil induced hyperalgesia

目的系统评价围术期应用N-甲基D-天冬氨酸受体拮抗剂预防瑞芬太尼诱发痛觉过敏的作用。方法检索Cochrane图书馆、Pub Med、Embase、Web of Science、OVID数据库,收集围术期应用N-甲基D-天冬氨酸受体拮抗剂预防瑞芬太尼的随机对照试验。由两位研究者根据纳入与排除标准筛选文献并进行质量评价后,提取文献中的相关资料,包括术后疼痛评分、首次术后镇痛药物需求时间、镇痛药物需求量,以及术后不良反应,利用Rev Man5.2软件进行Meta分析。结果最终筛选出12篇符合条件的文献,共纳入577例患者,其中对照组292例,N-甲基D-天冬氨酸受体拮抗剂组285例。Meta分析结果显示N-甲基D-天冬氨酸受体拮抗剂组的术后疼痛评分、首次术后镇痛药物需求时间以及镇痛药物需求量均低于对照组,两组术后恶心呕吐及出现精神症状的几率无显著性差异,但N-甲基D-天冬氨酸受体拮抗剂组出现视力障碍的几率明显高于对照组。结论 N-甲基D-天冬氨酸受体拮抗剂能够对抗瑞芬太尼诱发的痛觉过敏,但要注意使用后出现视力障碍。

Objective To systemically evaluate the effect of N-methyl-D-aspartate（ NMDA） receptor antagonist on protecting against remifentanil induced hyperalgesia. Methods The following databases as Cochrane Library,Pub Med,Embase,Web of Science and OVID were searched to collect the randomized controlled trials（ RCTs） with the administration of NMDA receptor antagonist vs. 0. 9% sodium chloride for patients receiving surgical pocedures under general anesthesia with the administration of remifentanil. Two reviewers screened literatures referring to trials according to the inclusion and exclusion criteria,and assessment of their quality. Data of postoperatiive visual analogue scales（ VAS）,time to the first analgesic request（ TFAR）,dosage of morphine consumed（ DMC）,and postoperative side effects were extracted and used to conduct Meta analysis with Rev Man5. 2 software. Results Ten studies included a total of 577 patients including 285 cases in NMDA receptor antagonist group and 292 cases in 0. 9% sodium chloride group. Meta analysis showed that VAS,TFAR,and DMC in NMDA receptor antagonist group were lower than those of 0. 9% sodium chloride group. There was no significant difference in postoperative nausea and vomiting（ PONV） and psychotomimetic adverse effects between these two groups. However,the incidence of visual disturbance in NMDA receptor antagonist group was higher than that of control group. Conclusion NMDA receptor antagonist can prevent remifentanil induced hyperalgesia,but postoperative visual disturbance should be cared.