右美托咪定联合地佐辛术后患者静脉自控镇痛的有效性和安全性的meta分析

Dexmedetomidine combined with dezocine for postoperative patient-controlled intravenous analgesia:a meta-analysis

目的系统评价右美托咪定联合地佐辛与单用地佐辛术后患者静脉自控镇痛(PCIA)的有效性和安全性。方法计算机检索Pub Med、Embase、Cochrane图书馆、CNKI、VIP等数据库,收集右美托咪定联合地佐辛术后静脉自控镇痛的随机对照试验(RCT),采用Rev Man 5.3软件对疼痛视觉模拟评分(Visual analogue scale,VAS)、镇静评分(Ramsay scale,RSS)、舒适度评分(Bruggrmann comfort scale,BCS)、不良反应进行meta分析。结果 VAS评分:联合用药组在术后12、24、48 h的VAS评分均较单用地佐辛组低,差异均有统计学意义(P<0.05);Ramsay评分:联合用药组在术后12 h镇静效果较单用地佐辛更为显著[WMD=0.84,95%CI(0.18,1.50)];BCS评分:联合用药组在12 h的BCS舒适度评分较单用地佐辛组高[WMD=0.57,95%CI(0.28,0.87),P<0.01];安全性:与单用地佐辛组相比,联合用药组术后恶心呕吐、头晕头痛、心跳过缓、皮肤瘙痒、嗜睡及总发生率显著降低;镇痛效果满意度:联合用药组的镇痛效果整体满意度明显高于单用地佐辛组[OR=5.00,95%CI(1.77,14.11),P<0.01]。结论与单用地佐辛组相比,右美托咪定联合地佐辛用于PCIA能获得较好的临床镇痛效果,并有效降低不良反应发生率,临床应用更为安全。

[Objective] To evaluate the efficacy and safety of dexmedetomidine combined with dezocine for postoperative patient-controlled intravenous analgesia（PCIA）.[Methods]The randomized controlled trials（RCT） about dexmedetomidine combined with dezocine for PCIA were electronically searched from database of Pub Med,Embase,Cochrane library,CNKI and VIP. Rev Man 5.3 software was used to conduct the meta-analysis on the visual analog scale score（VAS）,Ramsay score（RSS）,Bruggrmann comfort scale（BCS）and adverse reactions.[Results]The VAS scores at 12 hours,24 hours and 48 hours after operation in combination group were lower than those in dezocine group,and the differences were statistically significant（P〈0.05）. RSS scores showed that the sedation effect within 12 hours after operation in combination group was better than that in dezocine group[WMD=0.84,95%CI（0.18,1.50）]. BCS score within 12 hours after operation in combination group was higher than that in dezocine group[WMD=0.57,95%CI（0.28,0.87）,P〈0.01].The safety results showed that the total incidence rate of adverse reactions,and the incidence rate of nausea,vomiting,dizziness,headache,bradycardia,skin itch and sleepiness in combination group were lower than those in dezocine group. The satisfaction of analgesic effect in combination group was significantly better than that in dezocine group [OR =5.00,95% CI（1.77,14.11）,P〉0.01].[Conclusion] Compared with dezocine alone,dexmedetomidine combined with dezocine for PCIA has better clinical analgesic effect,and can effectively reduce the incidence rate of adverse reactions with higher security.