硬膜外腔注射不同剂量氢吗啡酮对剖宫产术后镇痛效果及安全性的Meta分析

Effect and Safety of Epidural Injection with Different Doses of Hydromorphone on Postoperative Analgesia After Cesarean Section:A Meta-Analysis.

目的比较硬膜外腔注射不同剂量氢吗啡酮对剖宫产术后镇痛效果及安全性。方法检索Pubmed、Embase、Web of science、Medline、中国知网、万方及维普数据库从建库至2021年8月,纳入术毕硬膜外腔注射低剂量(0.1 mg)、中剂量(0.2 mg)及高剂量(0.3~0.4 mg)氢吗啡酮对剖宫产术后镇痛效果比较的随机对照试验。主要结局指标为术后6、12、24 h VAS疼痛评分,次要结局指标为术后24 h PCA按压次数及术后不良反应发生率。用Revman5.3软件行Meta分析。结果纳入10项研究共1092例患者。中剂量组术后6、12 h VAS评分(P<0.05)及术后24 h PCA按压次数(P<0.05)均低于低剂量组。高剂量组术后6、12、24 h VAS评分(P<0.05)低于中剂量组。三组术后不良反应差异无统计学意义(P>0.05)。结论术毕硬膜外腔单次注射0.3~0.4 mg氢吗啡酮可能作为剖宫产术后镇痛的有效方式之一。

Objective To evaluate the effect and safety of epidural injection with different doses of hydromorphone on postoperative analgesia of cesarean section.Methods Literatures were retrieved from Pubmed,Embase,Web of Science,Medline,CNKI,Wanfang,and VIP databases up to August 2021.The Meta-analysis was performed using RevMan5.3 software.The primary outcome was the visual analogue scales(VAS)at 6 h,12 h,and 24 h after surgery,while the secondary outcome was the numbers of PCA compressions and the rates of postoperative adverse events.Results A total of 10 studies with 1092 patients were enrolled in this study.The VAS at 6 h,12 h(P<0.05),and the numbers of PCA compressions at 24 h(P<0.05)after surgery were both decreased in the middle-dose group compared with those in the low-dose group.The VAS at 6 h,12 h,and 24 h after surgery were decreased in the high-dose group compared with that in the middle-dose group(P<0.05).Meanwhile,there was no significant difference between the three groups concerning the rates of postoperative adverse events(P>0.05).Conclusion A single epidural injection with 0.3~0.4 mg hydromorphone may be one of the effective methods of analgesia after cesarean section.