帕瑞昔布对比氟比洛芬酯术后镇痛的疗效与安全性的Meta-分析

Efficacy and safety of parecoxib and flurbiprofen in treatment of pain after postoperative:a Meta-analysis

目的系统评价帕瑞昔布对比氟比洛芬酯用于术后镇痛的疗效和安全性。方法计算机检索中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、万方数据库、PubMed、Cochrane图书馆,收集帕瑞昔布对比氟比洛芬酯治疗术后疼痛随机对照试验(RCT),检索时间从建库至2019年10月。提取资料并进行文献质量评价后,使用RevMan 5.3软件进行Meta-分析。结果共纳入14篇RCTs,共984例患者,对照组采用氟比洛芬酯进行治疗,试验组采用帕瑞昔布进行治疗。Meta-分析结果显示:与氟比洛芬酯比较,帕瑞昔布显著降低术后6 h、12 h和24 h的疼痛评分(VAS)[SMD=-0.62、95%CI=-0.89^-0.35,SMD=-0.60、95%CI=-0.99^-0.20和SMD=-0.48、95%CI=-0.80^-0.15],降低不良反应(ADR)发生率[RR=0.60、95%CI=0.46~0.78],其中以降低头痛头晕发生率最显著[RR=0.55,95%CI=0.33~0.91],2组比较差异均有统计学意义(P<0.05);而对术后1 h、2 h和4 h的VAS评分,术后阿片用量,术后恶心呕吐发生率、皮肤瘙痒发生率、腹痛发生率和尿潴留发生率均无统计学差异。结论帕瑞昔布用于术后镇痛疗效和安全性优于氟比洛芬酯。

Objective To systematically evaluate the efficacy and safety of parecoxib and flurbiprofen for postoperative analgesia.Methods Databases including CNKl,CBM,Wanfang Data,PubMed and the Cochrane Library were searched from inception to October 2019.The randomized controlled trials(RCT)regarding the efficacy of parecoxib and flurbiprofen in the treatment of pain after postoperative were collected.Data were extracted and the quality of the study was evaluated.RevMan 5.3 software were used for result analysis.Results Fourteen randomized controlled trails were involved,containing 984 patients undergoing surgery.The experimental group was treated with parecoxib and the control group with flurbiprofen.Meta-analysis results showed that,compared with flurbiprofen,parecoxib significantly reduced pain scores(VAS)at 6 h,12 h,and 24 h after surgery[SMD=-0.62,95%CI=-0.89 to-0.35;SMD=-0.60,95%CI=-0.99 to-0.20 and SMD=-0.48,95%CI=-0.80 to-0.15],reduce the incidence of ADR[RR=0.60,95%CI=0.46 to 0.78],of which the most significant decrease in the incidence of headache and dizziness[RR=0.55,95%CI=0.33 to0.91],which the differences were statistically significant(P<0.05).And the VAS scores at 1 h,2 h and 4 h after surgery,postoperative opioid consumption,incidence of postoperative nausea and vomiting,incidence of skin itching,incidence of abdominal pain,and incidence of urinary retention,which the differences were not statistically significant.Conclusion The results show that parecoxib has better efficacy and safety than flurbiprofen for postoperative analgesia.