盐酸羟考酮与盐酸吗啡注射液在术后镇痛中的疗效对比及免疫功能影响的Meta分析

Comparison of Curative Effect of Oxycodone Hydrochloride and Morphine Hydrochloride Injection in the Postoperative Analgesia and Meta Analysis of Effect on Immune Function

目的疼痛是手术后患者最常见的症状之一,严重影响患者的生活质量及预后,盐酸羟考酮和吗啡注射液是临床上常用于镇痛治疗的强阿片类药物,该文旨在系统评价盐酸羟考酮注射液与吗啡注射液术后镇痛疗效及免疫功能影响差异以评价两者术后镇痛的临床疗效及安全性,为后续临床实践和研究提供参考依据。方法计算机检索万方,知网,维普,Pub Med,Embase、Cochrane图书馆临床对照试验收集盐酸羟考酮和吗啡注射液疗效及安全性的随机对照研究。检索时间均为从2006年1月—2015年12月。对符合条件的研究进行提取资料和质量评价后,纳入研究的质量由武汉科技大学附属医院两名评价者独立评价并提取资料、交叉核对,文献的异质性研究采用STATA 12.0软件及Rev Man 5.0软件进行meta分析。按照纳入的标准最终该研究共纳入9篇随机对照试验,包括860例病例,盐酸羟考酮组435例,吗啡组425例。结果共纳入9篇随机对照试验,包括860例病例。Meta分析结果显示:盐酸羟考酮注射液与吗啡注射液疼痛疗效[OR=7.72,95%CI(11.66,3.77),Z=2.3.83(P<0.05)],等效剂量盐酸羟考酮注射液疼痛控制情况明显优于吗啡注射液,生命体征的变化情况[OR=0.12,95%CI(-4.42,4.46),Z=0.05,P=0.96],差异无统计学意义(P>0.05),两者的不良反应比较[OR=1.99,95%CI(1.16,3.41),Z=2.51(P<0.05)],主要表现在呕吐方面,差异有统计学意义(P<0.05)。盐酸羟考酮注射液与吗啡注射液免疫功能分析结果相比[OR=6.46,95%CI(3.34,9.58),Z=4.06,P<0.05],两组差异有统计学意义(P<0.05)。结论盐酸羟考酮注射液与盐酸吗啡注射液相比在缓解术后急性疼痛方面效果良好,安全性高且对免疫功能影响较小。

Objective Pains is one of the most common symptoms of patients after operation, seriously affecting the quality of life and prognosis of patients, oxycodone hydroehloride and morphine hydrochloride injection is the strong o- pioid drugs in the analgesia therapy in clinic, the paper is to systematically evaluate the differences in the postoperative analgesia curative effect and effect on the immune function between the oxycodone hydrochloride and morphine hy- drochloride injection and provide reference for the clinical practice and research. Methods The curative effect and safety of oxycodone hydrochloride and morphine hydroehloride injection were randomly researched by retrieving Wan Fang, CNKI and VIP, PubMed, Embase and Cochrane library, and the retrieving time was from January 2006 to De- cember 2015, after the data extracting and quality evaluation, the quality included research was independently evaluat- ed by the two evaluators in Affiliated Hospital of Wuhan University of Science and Technology, and the heterogeneity was researched by the STATA 12.0 software and RevMan 5.0 software was used for meta analysis, finally, 9 articles were included finally for random and comparative test, including 860 cases, 435 cases in the oxvcodone hvdrochloride group and 425 cases in the morphine. Results 9 articles were included into the random and comparative test in total, including 860 cases, and the Meta analysis results showed that the pain curative effect of oxycodone hydrochloride in- jection and morphine injection [OR=7.72,95% CI（11.66,3.77）,Z=2.3.83 （P〈0.05）], and the equivalent-dose oxycodone hydrochloride pain control situation was obviously better than that of morphine injection, and the differences in the changes of vital signs between the two groups were not statistically significant[OR=0.12,95% CI（-4.42,4.46）,Z=O.O5,P= 0.96], and the differences in the adverse reactions between the two groups were hot statistically significant, [OR = 1.99,95% CI （1.16,3.41）,Z=2.51 （P〈0.05）], and the main manifestation was vomiting, and the difference in the analysis result of immune function between the oxycodone hydrochloride injection and morphine injection was statistically signif- icant, [0R=6.46,95% CI（3.34,9.58）,Z=4.06,P〈O.05]. Conclusion The effect of oxycodone hydrochloride in relieving the acute pains after operation is better than that of morphine hydrochloride injection with high safety and the effect on the immune function is small.