腹横肌平面阻滞用于肾移植术后镇痛有效性和安全性的Meta分析

Efficacy and Safety of Transversus Abdominis Plane Block for Analgesia after Renal Transplantation:A Meta-analysis

目的:系统评价腹横肌平面阻滞(TAPB)用于肾移植术后镇痛的有效性和安全性,以期为肾移植术后镇痛方案提供参考。方法:计算机检索PubMed、Embase和Cochrane、知网、万方、维普网数据库,搜集TAPB用于肾移植术后镇痛相关的随机对照试验,检索时限均从建库至2022年3月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Review Manager 5.3软件进行Meta分析。结果:共纳入10个随机对照试验(RCT),共503例患者。Meta分析结果显示:与对照组相比,TAPB组术后24 h视觉模拟量表(VAS)疼痛评分更低[SMD=-0.88,95%CI(-1.34~-0.42),P=0.0002],术中芬太尼[SMD=-3.41,95%CI(-6.07~-0.74),P=0.01]和术后芬太尼[SMD=-3.57,95%CI(-6.30~-0.84),P=0.01]、吗啡[SMD=-4.85,95%CI(-7.64~-2.06),P=0.0006]的用量更少。此外,两组患者术后胃肠道不良反应发生率[RR=1.03,95%CI(0.42~2.50),P=0.96]及术后24 h血肌酐水平[SMD=-1.02,95%CI(-3.28~1.23),P=0.37]差异无统计学意义。结论:现有证据表明,TAPB用于肾移植术后镇痛有效性好,安全性高,但仍需更多高质量研究进一步验证。

Objective:To systematically review the efficacy and safety of transversus abdominis plane block(TAPB)for analgesia after renal transplantation,in order to provide reference for analgesia after renal transplantation.Methods:PubMed,EMBASE,and Cochrane,CNKI,Wanfang,and VIP databases were searched by computer to collect randomized controlled trials(RCTs)related to TAPB for postoperative analgesia after kidney transplantation.The search time was from the database establishment to April 2022.After 2 reviewers independently screened the literature,extracted data and assessed the risk of bias of the included studies,Meta-analysis was performed using Review Manager 5.3 software.Results:A total of 10 RCTs with a total of 503 patients were included.Meta-analysis results showed that compared with the control group,the TAPB group had a lower VAS pain score at 24 h after operation[SMD=-0.88,95%CI(-1.34--0.42),P=0.0002],intraoperative fentanyl[SMD=-3.41,95%CI(-6.07--0.74),P=0.01],postoperative fentanyl[SMD=-3.57,95%CI(-6.30--0.84),P=0.01],and postoperative morphine[SMD=-4.85,95%CI(-7.64--2.06),P=0.0006]Use less.In addition,the incidence of postoperative gastrointestinal adverse reactions[RR=1.03,95%CI(0.42-2.50),P=0.96]and the 24 h postoperative serum creatinine level[SMD=-1.02,95%CI(-3.28-1.23)],P=0.37]of the two groups had no statistical difference.Conclusion:Existing evidence shows that TAPB is effective and safe for postoperative analgesia after kidney transplantation,but more high-quality studies are still needed for further verification.