胸科术后镇痛方式对患者术后疼痛程度影响的网状Meta分析

Effects of postoperatire analgesia methods on pain in patients after thoracic surgery:a network meta-analysis

目的:采用网状Meta分析方法比较6种术后镇痛方法对胸科手术术后疼痛的影响。方法:计算机检索The Cochrane Library、PubMed、CNKI、Wan Fang Date、VIP、CBM数据库,检索不同镇痛方法对胸科手术术后疼痛影响的随机对照试验,检索时限从2010年1月至2019年3月。由2位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。采用R3.3.5软件的Gemtc包进行数据分析。结果:共纳入17个研究,1071例胸科手术术后患者。术后24 h VAS评分的网状Meta分析结果显示:椎旁神经阻滞、硬膜外阻滞、前锯肌平面阻滞对胸科手术术后镇痛效果均优于静脉镇痛(P<0.05)。各神经阻滞法对于胸科手术术后患者镇痛效果排序(由好到差):硬膜外阻滞、竖脊肌平面阻滞、前锯肌平面阻滞、椎旁神经阻滞、肋间神经阻滞、静脉镇痛。结论:硬膜外阻滞效果最好,但考虑其操作复杂,并发症较多,可能并不是最佳选择。竖脊肌平面阻滞可能是胸科手术术后镇痛的最佳方法。受纳入文献数量及质量影响,上述结论仍需进一步验证。

Objective:To compare the effects of six postoperative analgesia methods on pain in patients after thoracic surgery using network meta-analysis.Methods:The Cochrane Library,PubMed,CNKI,Wan Fang Date,VIP and CBM databases were searched from Jan 2010 to Mar 2019,and randomized controlled trials of the effects of different analgesia methods on postoperative pain after thoracic surgery were collected.After literature screening,quality evaluation and data extraction,the Gemtc package of R3.3.5 software was used for meta-analysis.Results:A total of 17 studies were included in this meta-analysis,with 1071 patients after thoracic surgery.The results of network meta-analysis of 24 h VAS scores after surgery showed that paravertebral block,epidural block and serratus anterior plane block had better analgesic effects than intravenous analgesia after thoracic surgery(P<0.05).The order of analgesic effects of the six postoperative analgesia methods(from good to poor):epidural block,erector spinae plane block,serratus anterior plane block,paravertebral block,intercostal nerve block,intravenous analgesia.Conclusions:The analgesic effect of epidural block is the best,but considering its complicated operation and diverse complications,it may not be the best choice.The erector spinae plane block may be the best method for analgesia after thoracic surgery.Due to the quantity and quality of the included literature,the above results still need further verification.