甲硝唑对混合痔术后疼痛疗效评价的Meta分析

Effects of metronidazole on pain relief after mixed hemorrhoidectomy:a meta-analysis

目的系统评价甲硝唑对混合痔术后疼痛疗效。方法系统检索PubMed、Embase及Cochrane Library数据库中截止2020年9月发表的比较口服或静脉使用甲硝唑相对安慰剂治疗III~IV度混合痔并评价其对疼痛缓解疗效的随机对照研究(randomized controlled trial,RCT),并追溯相关文献的参考文献进行手工检索,由2位作者独立进行文献筛选、数据提取和文献偏倚评估(应用Cochrane Handbook for Systematic Reviews of Interventions v5.1.0)。用Stata 14.0软件对患者术后疼痛采用视觉模拟评分法(visual analogue scale,VAS)进行Meta分析。结果总共纳入9个RCT研究的476例患者,其中甲硝唑组239例,对照组237例。Meta分析结果显示,与对照组相比,使用甲硝唑的患者术后第1天、第2天、第7天及第14天的VAS疼痛评分均显著降低(第1天SMD=-0.68,95%CI:-1.33~-0.03;第2天SMD=-0.94,95%CI:-1.66~-0.22;第7天SMD=-0.76,95%CI:-3.28~-0.25;第14天SMD=-1.45,95%CI:-2.86~-0.03),且术后第1、2、7、14天VAS疼痛评分均未检测出明显的发表偏倚(P值均>0.1)。结论甲硝唑能显著改善混合痔术后患者的疼痛,是一种有效改善术后疼痛的方法。

Objective To evaluate systemically the efficacy of metronidazole in reducing postoperative pain after mixed hemorrhoidectomy.Methods Information retrieval was conducted through the access of PubMed,Embase and Cochrane Library databases published till September 2020 for papers of randomized controlled trials(RCTs)by comparing the effect of metronidazole with placebo or conventional therapy on postoperative pain relief in the patients with III-IV degree hemorrhoids who underwent hemorrhoidectomy.At the same time,literature search based on the obtained reference materials was also conducted manually.Then,literature screening,data extraction and bias evaluation were performed independently by 2 authors using Cochrane Handbook for Systematic Reviews of Interventions v 5.1.0.Finally,visual analogue scale(VAS)was used to evaluate post-operative pain through the access of meta analysis and Stata 14.0 software.Results Included in the study were a total of 476 patients from 9 RCTs,of whom 239 were assigned in the metronidazole group and 237 were designated in the control group.Meta analysis showed that VAS pain scores in the patients treated with metronidazole significantly lowered on day 1,day 2,day 7 and day 14 as compared with those of the control group(Day 1 SMD=-0.68,95%CI:-1.33--0.03;Day 2 SMD=-0.94,95%CI:-1.66--0.22;Day 7 SMD=-0.76,95%CI:-3.28--0.25;Day 14 SMD=-1.45,95%CI:-2.86--0.03),and no significant publication bias(P>0.1)was detected in the VAS pain scores on day 1,day 2,day 7 and day 14 after surgery.Conclusion Metronidazole could significantly alleviate pain in the patients with III-IV degree hemorrhoids who underwent hemorrhoidectomy,and proves to be an effective method to reduce postoperative pain.