胸椎旁阻滞用于乳腺手术麻醉的安全性及有效性的Meta分析

Efficacy and safety of thoracic paravertebral block for anesthesia in breast surgery:a meta-analysis

目的系统评价胸椎旁阻滞麻醉在乳腺手术中应用的安全性及有效性。方法计算机全面检索Pub Med、The Cochrane Library、Embase、springer、Wan Fang data、VIP和CNKI数据库,查找关于胸椎旁阻滞用于乳腺手术麻醉的随机对照试验(RCT),检索时限均从建库至2016年12月。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Rev Man 5.1软件进行Meta分析。结果共纳入7个研究,424例患者。Meta分析结果显示:与全身麻醉组相比,胸椎旁阻滞麻醉组用于乳腺手术阻滞成功率差异无统计学意义[RR=0.98,95%CI(0.95,1.01),P=0.20];术中芬太尼用量较少[MD=-43.03,95%CI(-53.31,-32.76),P<0.000 01];术后吗啡用量较少[MD=-3.80,95%CI(-6.10,-1.50),P=0.001];住院时间较短[SMD=-1.22,95%CI(-1.71,-0.73),P<0.000 01];PONV发生率较低[RR=0.33,95%CI(0.15,0.72),P=0.005];患者满意度较高[SMD=0.80,95%CI(0.36,1.24),P<0.000 4]。结论与全身麻醉比较,胸椎旁阻滞麻醉能有效用于乳腺手术,减少术中、术后镇痛药物使用,缩短住院时间,降低术后恶心、呕吐发生率,提高患者满意度。

Objective To systematically evaluate the efficacy and safety of thoracic paravertebral block for anesthesia in breast surgery.Methods The randomized controlled trials（RCTs） about thoracic paravertebral block for anesthesia in breast surgery in databases,including Pub Med,The Cochrane Library,Embase,Springer,Wan Fang data,VIP and CNKI,were searched from their inception to December 2016.Two reviewers screened literature according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality of included studies,and then metaanalysis was performed by using Rev Man 5.1 software.Results A total of 7 RCTs involving 424 patients were included.The results of meta-analysis showed that：compared with general anesthesia group,paravertebral block for anesthesia in breast surgery had similar success rate（RR=0.98,95%CI [0.95,1.01],P=0.20）,less intraoperative fentanyl consumption（MD=-43.03,95%CI [-53.31,-32.76],P〈0.000 01）,less postoperative morphine consumption（MD=-3.80,95%CI[-6.10,-1.50],P=0.001）,significantly shorter hospital stay（SMD=-1.22,95%CI [-1.71,-0.73],P〈0.000 01）,lower incidence of PONV（RR=0.33,95% CI [0.15,0.72],P=0.005）,and higher patient satisfaction（SMD=0.80,95% CI [0.36,1.24],P〈0.000 4）.Conclusion Compared with general anesthesia,thoracic paravertebral block for anesthesia is effective for breast surgery,which can reduce the use of analgesics during operation and postoperative analgesics,shorten hospitalization time,decrease the incidence of postoperative nausea and vomiting,and improve patient satisfaction.