盐酸曲马多与高乌甲素术后自控镇痛疗效与安全性的meta分析
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摘要
目的系统评价盐酸曲马多与高乌甲素术后患者自控镇痛(PCA)的临床效果与安全性。方法计算机检索Pub Med、The Cochrane Library、CBM、CNKI和Wan Fang Data,收集盐酸曲马多与高乌甲素术后PCA的随机对照试验(RCT),对纳入的RCT进行资料提取和质量评估后,对能够进行定量合成的结果采用Rev Man 5.2软件进行meta分析。结果共纳入11个RCT,共689例患者,meta分析结果显示:1 VAS评分:曲马多与高乌甲素组术后2、4、8、12、24和48 h评分均无统计学差异。2安全性:高乌甲素组术后恶心呕吐、头晕嗜睡、尿潴留等不良反应(ADR)的发生率较盐酸曲马多组低。结论现有证据表明,盐酸曲马多与高乌甲素术后PCA均能获得满意的镇痛效果,但高乌甲素ADR发生率低。但鉴于纳入研究的局限性,对该研究结果的可靠性尚需展开更多高质量、大样本的RCT予以证实。
[Objective]To evaluate the efficacy and safety of tramadol hydrochloride versus lappaconitine for patient-controlled analgesia(PCA).[Methods]The randomized controlled trials(RCTs) about tramadol hydrochloride versus lappaconitine for PCA were searched from Pub Med,Cochrane Library,CBM,CNKI and Wan Fang Data. The inclusion RCTs were treated by data extraction and quality assessment,the meta-analysis was performed by Rev Man 5.2 software.[Results]The results of metaanalysis showed that:1invisual analog scores(VAS):there were no significant differences in 2-hour,4-hour,8-hour,12-hour,24-hour and 48-hour scores between two groups. 2safety:the incidence rates of adverse reactions(ADRs),including nausea,vomiting,dizziness,drowsiness,and urinary retention,in lappaconitine group were lower than those in tramadol hydrochloride group.[Conclusion]According to the existing evidences,both of tramadol hydrochloride and lappaconitine can obtain satisfactory analgesia for PCA,but the incidence rate of ADRs in lappaconitine is lower. However,due to the limitations of the included RCTs,more high-quality and large-sample RCTs are needed to confirm the reliability of this study.
[Objective]To evaluate the efficacy and safety of tramadol hydrochloride versus lappaconitine for patient-controlled analgesia(PCA).[Methods]The randomized controlled trials(RCTs) about tramadol hydrochloride versus lappaconitine for PCA were searched from Pub Med,Cochrane Library,CBM,CNKI and Wan Fang Data. The inclusion RCTs were treated by data extraction and quality assessment,the meta-analysis was performed by Rev Man 5.2 software.[Results]The results of metaanalysis showed that:1invisual analog scores(VAS):there were no significant differences in 2-hour,4-hour,8-hour,12-hour,24-hour and 48-hour scores between two groups. 2safety:the incidence rates of adverse reactions(ADRs),including nausea,vomiting,dizziness,drowsiness,and urinary retention,in lappaconitine group were lower than those in tramadol hydrochloride group.[Conclusion]According to the existing evidences,both of tramadol hydrochloride and lappaconitine can obtain satisfactory analgesia for PCA,but the incidence rate of ADRs in lappaconitine is lower. However,due to the limitations of the included RCTs,more high-quality and large-sample RCTs are needed to confirm the reliability of this study.
引文
[1]陈富超,马光银,刘慧敏,等.曲马多联合布托啡诺术后静脉自控镇痛的meta分析[J].职业与健康,2013,29(18):2294-2297.
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[11]包长顺,包文朝,苏国友,等.不同剂量高乌甲素在腹部手术后皮下自控镇痛的观察[J].内蒙古民族大学学报:自然科学版,2007,22(6):670-671.
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[13]迟永良,苏帆.高乌甲素对围术期血糖、皮质醇、B-内啡肽的影响[J].山东大学学报,医学版,2008,46(3):313-316.
[14]李建军,张丽,陈颖,等.高乌甲素氯诺昔康和曲马朵用于鼻内镜术后患者自控镇痛的疗效对比研究[J].新医学,2005,36(9):535-536.
[15]胡正杨,王均炉,吴进泽,等.高乌甲素用于病人自控镇痛的效果观察[J].浙江创伤外科,2003,8(4):270-271.
[16]倪卫国,杨榕.布拉诺与曲马多用于术后PCIA的临床比较[J].河北医学,2004,10(1):62-64.
[17]佘守章.新型阿片类药物在病人自控镇痛中应用研究的进展[J].临床麻醉学杂志,2006:11(11):874-877.
[18]刘志龙,石翊飒.术后疼痛管理的研究进展[J].中国现代医药杂志,2010,12(9):132-133.
[2]方宝霞,刘杰,刘慧敏,等.曲马多联合氯诺昔康术后静脉自控镇痛疗效与安全性的meta分析[J].安徽医药,2013,17(9):1564-1567.
[3]刘铭佩.高乌甲素对炎症性疼痛的镇痛作用[J].中国药物与临床,2003,3(3):244-245.
[4]曾宪涛,李胜,马钻,等.Meta分析系列之八:meta分析的报告规范[J].中国循证心血管医学杂志,2012,4(6):500-503.
[5]唐轶洋,张兴安,阳婷婷,等.舒芬太尼与芬太尼用于术后硬膜外自控镇痛的系统评价[J].中国循证医学杂志,2012,12(12):1489-1496.
[6]余根远.高乌甲素与曲马多分别复合芬太尼术后镇痛作用比较[J].福建医药杂志,2010,32(1):133-133.
[7]高逸湘,周钦海,田伟千,等.高乌甲素与曲马多术后静脉镇痛的比较[J].实用疼痛学杂志,2005,1(4):211-212.
[8]洪建兵,万海方,郑汉光.高乌甲素用于人工髋关节置换术后患者自控镇痛的临床研究[J].浙江临床医学,2006,8(9):984.
[9]文化,郁葱.高乌甲素在骨科术后病人自控镇痛的疗效观察[J].现代医药卫生,2008,24(11):1601-1602.
[10]俞国灿,胡芳.高乌甲素和曲马多用于术后静脉镇痛效果的比较[J].浙江医学,2005,27(5):384-385.
[11]包长顺,包文朝,苏国友,等.不同剂量高乌甲素在腹部手术后皮下自控镇痛的观察[J].内蒙古民族大学学报:自然科学版,2007,22(6):670-671.
[12]汤昌明.高乌甲素与曲马多用于术后镇痛疗效的比较[J].海峡药学,2009,8(21):113.
[13]迟永良,苏帆.高乌甲素对围术期血糖、皮质醇、B-内啡肽的影响[J].山东大学学报,医学版,2008,46(3):313-316.
[14]李建军,张丽,陈颖,等.高乌甲素氯诺昔康和曲马朵用于鼻内镜术后患者自控镇痛的疗效对比研究[J].新医学,2005,36(9):535-536.
[15]胡正杨,王均炉,吴进泽,等.高乌甲素用于病人自控镇痛的效果观察[J].浙江创伤外科,2003,8(4):270-271.
[16]倪卫国,杨榕.布拉诺与曲马多用于术后PCIA的临床比较[J].河北医学,2004,10(1):62-64.
[17]佘守章.新型阿片类药物在病人自控镇痛中应用研究的进展[J].临床麻醉学杂志,2006:11(11):874-877.
[18]刘志龙,石翊飒.术后疼痛管理的研究进展[J].中国现代医药杂志,2010,12(9):132-133.
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