布托啡诺预防麻醉后寒战有效性和安全性的Meta分析

Meta Analysis of Efficacy and Safety of Tophenol in Preventing Shivering after Anesthesia

目的评价布托啡诺预防麻醉后寒战的有效性和安全性。方法应用计算机检索CNKI、Wanfang、VIP、PubMed、Cochrane Library、Embase等数据库,收集自建库至2021年8月14日有关布托啡诺预防麻醉术后寒战的随机对照试验文献,研究组为布托啡诺,对照组至少包含0.9%氯化钠注射液、曲马多、芬太尼及哌替啶中一个或多个,采用RevMan5.3对数据进行Meta分析,根据不同对照组、麻醉方式进行亚组分析。结果共纳入15项研究,1580例受试者。在有效性方面,布托啡诺组寒战率明显低于0.9%氯化钠注射液组(RR=0.18,95%CI:0.13~0.25,P<0.001)、芬太尼组(RR=0.32,95%CI:0.16~0.63,P=0.001)和哌替啶组(RR=0.71,95%CI:0.52~0.97,P=0.030);与曲马多组(RR=0.60,95%CI:0.23~1.60,P=0.310)比较,差异无统计学意义;在不同麻醉方式亚组(全身麻醉、硬膜外麻醉和腰硬联合麻醉)中,布托啡诺组寒战发生率低于0.9%氯化钠注射液组(RR=0.18,95%CI:0.08~0.42,P<0.001);在安全性方面,布托啡诺组恶心、呕吐发生率低于哌替啶组(RR=0.09,95%CI:0.03~0.24,P<0.001)和曲马多组(RR=0.23,95%CI:0.11~0.51,P<0.001),与0.9%氯化钠注射液组(RR=0.89,95%CI:0.47~1.69,P=0.720)比较,差异无统计学意义;布托啡诺组嗜睡发生率高于0.9%氯化钠注射液组(RR=31.94,95%CI:9.03~113.04,P<0.001),与哌替啶组(RR=2.38,95%CI:0.78~7.19,P=0.130)和曲马多组(RR=0.84,95%CI:0.45~1.57,P=0.590)比较,差异无统计学意义;布托啡诺组呼吸抑制发生率与0.9%氯化钠注射液组(RR=5.00,95%CI:0.61~41.26,P=0.130)比较,差异无统计学意义。结论布托啡诺可以有效预防麻醉术后寒战的发生,效果与哌替啶、曲马多及芬太尼相当,且在促进镇静的同时未增加恶心、呕吐及呼吸抑制的发生率。

Objective To evaluate the efficacy and safety of Butorphanol in preventing shivering after anesthesia.Methods CNKI,Wanfang,VIP,PubMed,Cochrane Library,EMBASE and other databases were searched by computer,and the randomized controlled experimental literature on Butorphanol in the prevention of shivering after anesthesia from the establishment of the database to August 14,2021 was collected.The study group was butorphanol,and the control group included at least one or more of normal saline,tramadol,fentanyl and pethidine,Revman5.3 was used for Meta-analysis of the data,and subgroup analysis was carried out according to different control groups and anesthesia methods.Results A total of 15 studies and 1580 subjects were included.In terms of effectiveness,the shivering rate in butorphanol group was significantly lower than that in normal saline group(RR=0.18,95%CI:0.13-0.25,P<0.001),fentanyl group(RR=0.32,95%CI:0.16-0.63,P=0.001)and pethidine group(RR=0.71,95%CI:0.52-0.97,P=0.030);There was no significant difference compared with tramadol group(RR=0.60,95%CI:0.23-1.60,P=0.310).The incidence of shivering in butorphanol group was lower than that in normal saline group(RR=0.18,95%CI:0.08-0.42,P<0.001).In terms of safety,the incidence of nausea and vomiting in butorphanol group was lower than that in pethidine group(RR=0.09,95%CI:0.03-0.24,P<0.001)and tramadol group(RR=0.23,95%CI:0.11-0.51,P<0.001),and there was no significant difference as comparing with normal saline group(RR=0.89,95%CI:0.47-1.69,P=0.720).The incidence of drowsiness in butorphanol group was higher than that in normal saline group(RR=31.94,95%CI:9.03-113.04,P<0.001),and there was no significant difference between pethidine group(RR=2.38,95%CI:0.78-7.19,P=0.130)and tramadol group(RR=0.84,95%CI:0.45-1.57,P=0.590).There was no significant difference in the incidence of respiratory depression between butorphanol group and normal saline group(RR=5.00,95%CI:0.61-41.26,P=0.130).Conclusion Butorphanol can effectively prevent the occurrence of shivering after anesthesia,which is equivalent to pethidine,tramadol and fentanyl,and does not increase the incidence of nausea,vomiting and respiratory depression while promoting sedation.