加巴喷丁术前用药在开腹子宫切除术后镇痛效应的Meta分析

Efficacy of gabapentin in preemptive analgesia for hysterectomy:a meta-analysis of randomized controlled trials

目的系统评价加巴喷丁术前用药对开腹子宫切除术患者术前用药的效果及安全性。方法电子检索PubMed、Cochrane、Embase、Ovid、Springer Link、Web of Science、CNKI、万方、维普等数据库,收集2000~2016年发表的加巴喷丁术前用药的随机对照试验(randomized controlled trial,RCT)文献,按Cochrane指导手册的方法选择文献、提取资料及评价研究质量后,采用RevMan5.3软件进行Meta分析。结果共纳入10篇RCT文献,共计609例患者。Meta分析结果显示,与对照组比较,加巴喷丁组术后24h阿片类麻醉药物的累积用量明显减少(WMD=-8.83mg,95%CI-12.70^-4.97,P<0.001);VAS评分无明显降低(WMD=-7.70mm,95%CI-18.22~2.82,P=0.15);呕吐的发生率明显降低(RR=0.49,95%CI 0.35~0.69,P<0.001)。两组术后24h内恶心的发生率(RR=0.73,95%CI 0.45~1.17,P=0.19)和嗜睡的发生率(RR=2.08,95%CI0.62~6.92,P=0.23)差异无统计学意义。结论开腹子宫切除术的患者加巴喷丁术前用药能够有效地降低阿片类麻醉药物的累积用量,减少呕吐的发生率,而对术后疼痛、恶心以及嗜睡无明显影响。

Objective To evaluate the efficacy and safety of gabapentin in preemptive analgesia for hysterectomy after general anesthesia. Methods PubMed, Cochrane, Embase, Ovid, Springer Link, Web of Science, CNKI, Wanfang and Weipu databases were searched for randomized placebo- controlled trials involving the efficacy of gabapentin for preemptive analgesia published from 2000 to 2016. The methodological quality of the included randomized controlled trial （RCT） was assessed and the data were extracted according to the Cochrane Handbook. The meta-analysis was performed using the RevMan 5.3 software. Results A total of 10 RCTs involving 609 patients were included. Compared with the control group, there was a significant decrease in 24-hour cumulative narcotic consumption at 24 hours when gabapentin was administered before surgery （WMD=-8. 83 rag, 95 %CI -12.70- -4. 97, P〈0. 001）, there was no significant decrease in VAS score in preemptive analgesia group （WMD=-7.70 ram, 95%CI -18. 22-2.82, P=0. 15）. Compared with the control group, the rate of vomiting was less in the gabapentin group （RR=0. 49, 95%CI 0. 35-0. 69, P〈0. 001）. Compared with the placebo group, there was no significant decrease in nausea （RR ：0. 73, 95%CI 0. 45-1.17, P=0.19） and somnolence （RR=2. 08, 95%CI O. 62-6.92, P=0. 23）. Conclusion Preemptive administration of gabapentin is effective in decreasing accumulation of opium and vomiting.