吸烟对术后阿片类镇痛药需求量影响的Meta分析

Effects of smoking on postoperative opioids consumption for postoperative analgesia： a Meta-analysis

目的系统评价吸烟对术后阿片类镇痛药需求量的影响。方法计算机检索Cochrane图书馆、PubMed、EMbase、CBM、CNKI和万方数据等数据库，检索吸烟对术后阿片类镇痛药使用量影响的临床队列研究，由两名评价员独立按照纳入与排除标准筛选文献，对纳入的文献进行资料提取、质量评价及数据转换，采用RevMan5．3软件进行Meta分析。结果共纳入11个队列研究，1648例患者，其中非吸烟患者1029例，吸烟患者619例；质量评价结果显示文献总体研究质量较高。Meta分析结果显示，吸烟组患者术后自控镇痛阿片类药物静脉吗啡当量24h总用量[标准均数差（standardized mean difference，SMD）：1．67，95％CI（0．99，2．35），P〈0．05]、单位体重24h用量[SMD=1．29，95％CI（0．21，2．37），P〈0．05]，48h总用量[SMD=0．56，95％CI（0．29，0．83），P〈0，05]以及单位体重48h用量[SMD=0．67，95％CI（0．43，0．91），P〈0．05]均高于非吸烟组；术后恶心呕吐、瘙痒等阿片类药物副作用发生率差异无统计学意义（P〉0．05）。结论吸烟患者较不吸烟患者术后可能对疼痛更敏感，需要更多的阿片类镇痛药，鉴于纳入研究的局限性，上述结论仍需进一步研究。

Objective To systemically review the literature about the effects of smoking on opioids consumption for postoperative pain. Methods Literature about cohort studies in effects of smoking on postoperative opioids consumption was obtained from several sources, including the Cochrane Library, PubMed, EMbase, CBM, CNKI, and Wanfang database. Two reviewers independently screened the literatures using the same inclusion and exclusion criteria, subsequently performed data extraction, quality assessment, data conversion, and Meta-analysis with RevMan 5.3 software. Results A total of 11 cohort studies involving 1 029 nonsmokers and 619 smokers were finally included. Meta-analysis showed that the first 24 h postoperative intravenous morphine equivalent [standardized mean difference （SMD）=1.67, 95%CI （0.99, 2.35）, P〈0.05], weight -adjusted 24 h intravenous morphine equivalent [（SMD=1.29, 95%CI（0.21, 2.37）, P〈0.05], the first 48 h postoperative intravenous morphine equivalent [（SMD=0.56, 95%CI （0.29, 0.83）, P〈0.05], and weight-adjusted 48 h intravenous morphine equivalent （SMD=0.67, 95%CI（0.43, 0.91）, P〈0.05） in smokers are significantly higher than nonsmokers for patient controlled analgesia, and there is no statistical difference in the incidence of postoperative nausea, vomiting, and pruritus between smokers and non-smokers （P〉0.05）. Conclusions Smokers may be more sensitive to pain after surgery and require more opioids for analgesia. The stringent inclusion criteria in this study might limit the generalization of the conclusion. Further meta-analysis with less stringent inclusion criteria are warranted to confirm the results.