地佐辛联合曲马多术后静脉自控镇痛有效性和安全性的Meta分析

Efficacy and Safety of Dezocine Combined with Tramadol in Postoperative Patient-cotrolled Intravenous Analgesia: A Meta-analysis

目的:采用Meta分析方法评价地佐辛联合曲马多与单用曲马多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、Web of Science、Embase、The Cochrane Library、CNKI、Wan Fang Data、Sino Med和VIP数据库,收集地佐辛联合曲马多术后PCIA的随机对照试验(RCTs),检索时限均为1995年1月~2017年12月。由两位评价员独立筛选文献、提取资料并评价纳入研究的方法学质量后,使用Rev Man 5.3软件进行Meta分析。结果:共纳入有效文献13篇,累计939例患者。Meta分析结果显示,(1)视觉模拟评分法(VAS)评分:联合用药组在术后12,24,48 h的VAS评分均较单用曲马多组低,且差异均有统计学意义(P<0.05);(2)镇静评分(Ramsay):联合用药组在术后24,48 h镇静效果较单用曲马多更为显著[24 h:WMD=-0.34,95%CI(-0.54,-0.13);48 h:WMD=-0.21,95%CI(-0.28,-0.13),P<0.05];(3)舒适度评分(BCS):联合用药组在48 h的舒适度评分较单用曲马多组低[WMD=-0.08,95%CI(-0.12,-0.03),P<0.01];(4)安全性:与单用曲马多组相比,联合用药组术后恶心呕吐、皮肤瘙痒、呼吸抑制、头晕头痛及不良反应总发生率显著降低。结论:与单用曲马多组相比,地佐辛联合曲马多用于PCIA能获得较好的临床镇痛效果,并有效降低不良发应发生率,临床应用更为安全。

Objective： To evaluate the efficacy and safety of dezocine combined with tramadol for patient-controlled analgesia（ PCA）. Methods： The randomized controlled trials of dezocine combined with tramadol for PCA were gathered from Pub Med,Web of science,Embase,The Cochrane Library,CNKI,Wan Fang Data,Sino Med and VIP database from January 1995 to December 2017. Two reviewers independently screened literature,extracted data and assessed qualified of included studies. Then,Meta-analysis was performed by Rev Man 5. 3 software. Results： Thirteen trials comprising 939 patients were included in the Meta-analysis. The results of Meta-analyses showed that：（1） as for visual analog scale（ VAS） score,compared with the tramadol group,the combination group（ dezocine combined with tramadol） had significant differences at 12 h,24 h and 48 h post-operation;（2） as for Ramsay sedation score,compared with the tramadol group,the ramsay score at 24 h,48 h had significant differences when dezocine combined with tramadol [24 h： WMD =-0. 34,95% CI（-0. 54,-0. 13）; 48 h： WMD =-0. 21,95% CI（-0. 28,-0. 13）,P〈0. 05];（3） there were significant differences in bruggrmann comfort scale of PCA at 48 h post-operation between the combined group and the single tramadol group [WMD =-0. 08,95% CI（-0. 12,-0. 03）,P〈0. 01];（4） as for adverse reaction in the combination group compared with the single tramadol group,nausea and vomiting,skin itching,respiratory depression,dizziness and headache and incidences of adverse reaction were significantly decreased. Conclusion： According to the domestic evidence,dezocine combined with tramadol for PCA could effectively alleviate postoperative pain compared with tramadol alone,and could be able to reduce the incindence of adverse reactions.