舒芬太尼联合地佐辛与单用舒芬太尼比较用于术后镇痛有效性和安全性的Meta分析

Efficacy and safety of the combination of dezocine and sufentanil versus sufentanil for postoperative analgesia: a meta-analysis

目的 系统评价舒芬太尼联合地佐辛(DS组)对比单用舒芬太尼(S组)用于患者术后镇痛的有效性和安全性。方法 计算机检索CNKI、WanFang Data、VIP、PubMed、Wiley Online Library和ScienceDirect数据库,搜集DS与S比较用于术后镇痛的随机对照试验(RCT),检索时限为2011年1月至2017年7月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 13.0软件进行Meta分析。结果 共纳入39个RCT。Meta分析结果显示:地佐辛剂量为0.2 mg/kg时,DS组在2 h、6 h、12 h、24 h和48 h时点上的VAS评分低于S组,其差异均有统计学意义。地佐辛剂量为0.3 mg/kg时,DS组和S组在2 h和4 h时点上VAS评分不存在显著差异;但DS组在6 h、12 h、24 h和48 h时点上的VAS评分低于S组,其差异均有统计学意义。地佐辛剂量为10 mg/kg时,各个时点上DS组和S组均不存在显著差异。在患者镇痛满意度方面,DS组在"优秀率"和"良好率"上均优于S组,其差异有统计学意义。在不良反应方面,DS组不良反应发生率低于S组,其差异有统计学意义。结论 当前证据显示,舒芬太尼联合地佐辛术后镇痛效果优于单用舒芬太尼,且其不良反应发生率更低。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically evaluate the efficacy and safety of dezocine combine with sufentanil(DS)versus sufentanil(S)for postoperative analgesia.Methods CNKI,WanFang Data,VIP,PubMed,Wiley Online Library and ScienceDirect databases were searched online to collect randomized controlled trials(RCTs)of DS versus S for postoperative analgesia from January2011to July2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,meta-analysis was performed by using Stata13.0software.Results A total of39RCTs were included.The results of meta-analysis showed that:DS group had higher scores on VAS at2h,6h,12h,24h and48h points than S group at the dezocine level of0.2mg/kg.At the dezocine level of0.3mg/kg,there were no significant differences in scores on VAS at2h and4h.However,DS group had higher scores at6h,12h,24h and48h points.At the dezocine level of10mg/kg,there were no significant differences in scores on VAS at each time point in both groups.DS group was superior to S group in"excellent rate"and"good rate"of the analgesic satisfaction of patients.For safety,the incidence of postoperative nausea and vomiting of DS group was lower than S group.Conclusions The current evidence shows that dezocine combine with sufentanil have more effects of postoperative analgesia than sufentanil alone,and its incidence of adverse reactions is lower.Due to limited quality and quantity of the included studies,more high-quality studies are needed to verify above conclusions.