复方苦参注射液联合阿片类镇痛药用于恶性肿瘤患者疼痛效果的Meta分析

Meta-analysis of compound matrine injection combined with opioid analgesics in treatment of pain in patients with malignant tumor

目的 系统评价阿片类镇痛药联合复方苦参注射液用于治疗癌痛患者的止痛疗效和安全性.方法 计算机检索CBM、CNKI、Wanfang、VIP、PubMed等,辅助手工检索相关期刊杂志,收集复方苦参注射液联合癌痛标准治疗方案对癌痛患者治疗效果的随机对照试验（RCTs）;由2名研究员独立按照纳入排除标准选择RCTs,先对入选的研究进行质量评价,提取相应的数据并采用Revman5.3系统评价软件进行Meta分析.结果 共纳入15项研究,Meta分析结果显示,与单纯使用阿片类止痛药比较,复方苦参注射液联合阿片类药物对晚期癌症患者进行镇痛治疗,可以提高镇痛有效率（RR=2.45,95％CI=1.84 ～ 3.25,P＜0.01）、改善患者生活质量（RR=1.59,95％CI=1.14～2.22,P＜0.01）、减少不良反应的发生（RR=0.60,95％CI=0.44～0.82,P＜0.01）,特别是对阿片类镇痛药物引起的常见不良反应如恶心、嗜睡、便秘等,改善明显.结论 阿片类镇痛药联合复方苦参注射液相比单用阿片类镇痛药,可以提高患者治疗的有效率、减少阿片类镇痛药造成的不良反应,使癌痛患者的生活质量得以改善,更易为晚期癌症患者所接受,值得进一步研究及临床推广.

Objective To systemically evaluate the analgesic efficacy and safety of compound matrine Injection in combination with opioid analgesic for pain of patients with malignant tumor.Methods We searched CBM,CNK1,Wanfang,VIP,PubMed with computer and searched some related journals and magazines in this field to collect randomized control trials （RCTs） of standard treatment for cancer pain combined with compound matrine injection.Two researchers selected RCTs independently according to inclusion and exclusion criteria and did quality assessment and data extraction,and then used the Revman 5.3 software for meta-analysis.Results 15 studies were included in the systematic review,covering a total of 1 712 patients.The results of meta-analysis showed that compared with opioid analgesic treatment alone,compound matrine injection and opioid analgesic treatment could significantly increase the efficacy （P 〈0.01）,improve quality of life （P 〈0.01）,and reduce the incidence of adverse reactions （P 〈0.01）,such as nausea,lethargy,constipation,and so on.Conclusion Compared with opioid analgesic treatment alone,compound matrine injection combined with opioid analgesics could significantly improve the analgesic efficacy and QOL and reduce adverse events.