选择性COX-2抑制剂用于髋/膝关节置换术超前镇痛有效性及安全性的Meta分析

Efficacy and safety of selective COX-2 inhibitors for preemptive analgesia in patients undergoing total hip/knee arthroplasty:a meta-analysis

目的系统评价选择性环氧合酶2(COX-2)抑制剂用于人工全髋/膝关节置换术(THA/TKA)超前镇痛的效果与安全性,为临床用药提供循证参考。方法计算机检索中国知网、维普网、中国生物医学文献服务系统、万方数据、PubMed、Embase、Scopus、Web of Science和Cochrane图书馆,收集选择性COX-2抑制剂用于THA/TKA超前镇痛联合术后镇痛(试验组)对比单纯术后镇痛(对照组)的随机对照试验(RCT),检索时间均为建库起至2022年2月15日。筛选文献、提取资料后采用Cochrane系统评价员手册5.1.0推荐的RCT偏倚风险评估工具对纳入文献进行质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入6项RCT,合计916例患者。与对照组比较,试验组患者术后的静息状态下[MD=-0.20,95%CI(-0.30,-0.10),P<0.0001]和活动状态下[MD=-0.20,95%CI(-0.27,-0.13),P<0.00001]的疼痛视觉模拟法评分、患者自控镇痛(PCA)药物总消耗量[MD=-5.89,95%CI(-8.98,-2.80),P=0.0002]、术后恶心呕吐发生率[RR=0.79,95%CI(0.65,0.95),P=0.01]均显著低于对照组。结论选择性COX-2抑制剂超前镇痛联合术后镇痛,较单纯术后镇痛可明显减轻THA/TKA患者术后早期疼痛,减少PCA药物总消耗量,降低术后恶心呕吐发生率。

OBJECTIVE To systematically evaluate the efficacy and safety of selective COX-2 inhibitors for preemptive analgesia in patients undergoing total hip/knee arthroplasty(THA/TKA),and to provide evidence-based reference for clinical drug use.METHODS Retrieved from CNKI,VIP,CBM,Wanfang database,PubMed,Embase,Scopus,Web of Science and Cochrane library,randomized controlled trials about selective COX-2 inhibitors for preemptive analgesia combined with postoperative analgesia of THA/TKA(trial group)versus post-operative analgesia(control group)were collected during the inception to February 15,2022.After screening the literature and extracting the data,the RCT bias risk assessment tool recommended by the Cochrane System Evaluator’s Manual 5.1.0 was used to evaluate the quality of the included literature.Meta-analysis was performed by using RevMan 5.3 software.RESULTS Six RCTs involving 916 patients were included.The visual analog(VAS)scale scores of pain at rest [MD=-0.20,95%CI(-0.30,-0.10),P<0.000 1],VAS scores of pain at movement [MD=-0.20,95%CI(-0.27,-0.13),P<0.000 01],total consumption of patient controlled analgesia(PCA) [MD=-5.89,95%CI(-8.98,-2.80),P=0.000 2],and the incidence of postoperative nausea and vomiting [RR=0.79,95%CI(0.65,0.95),P=0.01] in trial group were significantly lower than control group.CONCLUSIONS Compared with postoperative administration alone,preemptive plus postoperative analgesia with selective COX-2 inhibitor can significantly alleviate the early postoperative pain,reduce the total consumption of PCA and the incidence of postoperative nausea and vomiting in THA/TKA patients.