住院新生儿药物镇痛有效性和安全性的系统评价/Meta分析再评价

Effectiveness and safety of pharmacological interventions for hospitalized neonatal pain:an overview of systematic review and meta-analysis

目的对住院新生儿药物镇痛有效性和安全性的系统评价/Meta分析进行再评价,为新生儿镇痛管理实践提供循证依据。方法计算机检索中国知网、中国生物医学文献数据库、万方数据、维普网、PubMed、Embase、Cochrane图书馆、Web of Science、CINAHL数据库及Google学术,收集住院新生儿药物镇痛的系统评价/Meta分析。检索时限均为2016年11月1日至2021年11月1日。筛选文献并提取资料后,采用AMSTAR 2量表评价纳入文献的方法学质量,采用证据推荐分级的评估、制订与评价(GRADE)方法评价结局指标的证据质量并进行汇总分析。结果共纳入7篇系统评价/Meta分析,共36个结局指标。AMSTAR 2评价结果显示,5篇文献的方法学质量等级为中等质量,2篇为极低质量。GRADE证据质量评价结果显示,36个结局指标中,中级指标有7个(19.44%)、低级指标有22个(61.11%)、极低级指标有7个(19.44%);造成证据质量降级的原因主要为研究结果的不精确性(71.74%)。结论阿片类药物能显著降低机械通气新生儿的疼痛评分,但可能会增加低血压发生率;对乙酰氨基酚能显著降低新生儿眼科检查的疼痛评分,减少术后吗啡用量,且无不良反应报告,但其对操作性疼痛的镇痛效果不及葡萄糖和蔗糖;利丙双卡因和丁卡因可缓解住院新生儿静脉穿刺疼痛和腰椎穿刺疼痛,但利丙双卡因可能会增加不良反应的发生风险;可乐定可降低新生儿机械通气性疼痛,且无不良反应报告。建议新生儿科医师根据临床判断和疼痛评估结果选择性地使用镇痛药物。

OBJECTIVE To conduct overview of the systematic review(SR)/meta-analysis for the effectiveness and safety of pharmacological interventions for hospitalized neconatal pain,and to provide evidence-based reference for neonatal pain management.METHODS CNKI,CBM,Wanfang,VIP,PubMed,Embase,the Cochrane Library,Web of Science,CINAHL and Google Scholar were searched for SR/meta-analysis of pharmacological interventions for hospitalized neonatal pain.The search period was from Nov.1st,2016-Nov.1st,2021.After literature screening and data extraction,AMSTAR 2 scale was used to evaluate the methodological quality of the included literature,and GRADE method was used to assess the evidence quality of the outcome of the included literature.A summary analysis was then conducted.RESULTS Totally 36 outcome indexes of 7 SR/meta-analysis were included.Five studies were of moderate quality,and two were very poor according to AMSTAR 2 scale.GRADE results showed that among 36 outcome indexes,there were 7 moderate-quality indexes(19.44%),22 low-quality indexes(61.11%),and 7 critically-low-quality indexes(19.44%).The main reason for downgrading the quality of evidence was imprecision of results(71.74%).CONCLUSIONS Opioids can significantly reduce the pain score of mechanically ventilated neonates but may increase hypotension.Acetaminophen can significantly reduce pain scores during eye examinations and postoperative morphine consumption with no adverse reaction report.However,its analgesic effect on procedural pain is less than glucose and sucrose.Lidocaine and prilocaine and tetracaine may relieve venipuncture and lumbar puncture pain but lidocaine and prilocaine may increase the risk of adverse reaction.Clonidine can reduce neonatal mechanical ventilation pain with no adverse reaction report.It is suggested that neonatal pediatricians should use analgesic drugs selectively based on clinical judgment and pain assessment results.