氟比洛芬酯联合地佐辛在术后静脉自控镇痛中有效性和安全性的系统评价

Effectiveness and safety of flurbiprofen axetil combined with dezocine for postoperative patient-controlled intravenous analgesia： a systematic review

目的系统评价氟比洛芬酯联合地佐辛在术后静脉自控镇痛（PCIA）中的有效性和安全性。方法计算机检索 PubMed，Web of science，ISI，Cochrane database of systematic reviews，Embase，中国期刊全文数据库、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库，纳入氟比洛芬酯联合地佐辛用于术后PCIA的随机对照试验（RCT）。将患者分为氟比洛芬酯联合地佐辛组（联合用药组），单用氟比洛芬酯组（F组）和单用地佐辛（D组）。按照纳入与排除标准进行文献筛选及数据提取，记录患者术后PCIA中的疼痛视觉模拟量表（VAS）评分、Ramsay评分和术后不良反应。采用RevMan 5.3软件进行Meta分析。结果共纳入14个RCT，共1 246例患者。Meta分析结果显示，联合用药组术后12、24、48 h VAS评分低于D组，术后12、24 h VAS评分低于F组，术后12、24 h Ramsay评分低于D组，8、12、24 h Ramsay评分低于F组（均P〈0.05）。联合用药组恶心呕吐、嗜睡发生率和不良反应总发生率明显低于D组（比值比=0.23、0.29、0.22，95%置信区间：0.14~0.35、0.11~0.77、0.15~0.32，P〈0.05）和F组（比值比=0.23、0.25、0.18，95%置信区间：0.12~0.47、0.09~0.69、0.10~0.31，P〈0.05）。结论与单用地佐辛或氟比洛芬酯相比，氟比洛芬酯联合地佐辛在术后PCIA中具有较好的镇痛镇静效果，明显降低不良发应发生率。

ObjectiveTo evaluate effectiveness and safety of flurbiprofen axetil combined with dezocine for postoperative patient-controlled intravenous analgesia（PCIA）. MethodsRandomized clinical trials about flurbiprofen axetil combined with dezocine for postoperative PCIA were searched in PubMed, Web of Science, ISI, Cochrane Database of Systematic Reviews, Embase, Chinese Journal Full-text Database, Wanfang Database, VIP Database and China Biology Medicine Database. Patients were divided into flurbiprofen plus dezocine group, flurbiprofen group and dezocine group. Clinical data including Visual Analogue Scale（VAS） score, Ramsay score and postoperative adverse reactions were abstracted. Meta analysis was conducted using RevMan 5.3 software. ResultsTotally 1 246 patients in 14 trails were included in present analysis. In flurbiprofen plus dezocine group, postoperative 12, 23, 48 h VAS scores were significantly lower than those in dezocine group; postoperative 12, 24 h VAS score were significantly lower than those in flurbiprofen group; postoperative 12, 24 h Ramsay score were significantly lower than those in dezocine group; postoperative 8, 12, 24 h Ramsay score were significantly lower than those in flurbiprofen group（P〈0.05）. Incidences of nausea, vomiting, drowsiness and the total incidence of adverse reactions in flurbiprofen plus dezocine group were significantly lower than those in dezocine group（odds radio=0.23, 0.29, 0.22, 95% confidence interval： 0.14-0.35, 0.11-0.77, 0.15-0.32, P〈0.05） and flurbiprofen group（odds radio=0.23, 0.25, 0.18, 95% confidence interval： 0.12-0.47, 0.09-0.69, 0.10-0.31, P〈0.05）. ConclusionPostoperative PCIA with flurbiprofen plus dezocine has better analgesia and sedation effects and less adverse effects compared with using flurbiprofen or dezocine alone.