布比卡因与新斯的明联用对小儿尿道下裂术后镇痛效果的系统评价  

Effectiveness of Caudal Bupivacaine with Neostigmine for Postoperative Pain Management after Hypospadias Surgery in Children:A Systematic Review

作　　者：兰蕴平[1] 黄振华[1] 左云霞[1] 

机构地区：[1]四川大学华西医院麻醉科,成都610041

出　　处：《中国循证医学杂志》2009年第6期670-673,共4页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价新斯的明与布比卡因联用骶管阻滞对小儿尿道下裂术后镇痛的效果。方法检索Cochrane图书馆(2008年第2期)、MEDLINE(1966～2008)、EMbase(1980～2008)、中国生物医学文献光盘数据库(CBMdisc,1978～2008)、中文科技期刊全文数据库(1989～2008)及万方数据库,收集有关布比卡因与新斯的明联用骶管阻滞在小儿尿道下裂术后镇痛效果与单纯使用布比卡因比较的随机对照试验。由两名评价员独立评价文献,对符合入选标准的研究用RevMan5.0.13进行Meta分析。结果共纳入3个研究,包括160例患者,其方法学质量均为偏倚风险不确定。Meta分析结果显示:布比卡因与1μg/kg新斯的明联用进行骶管阻滞与单用布比卡因比较,其镇痛时间差异无统计学意义[WMD=0.05,95%CI(-6.76,6.86),P=0.99];而布比卡因与2μg/kg、3μg/k和4μg/kg新斯的明联用进行骶管阻滞与单用布比卡因比较,其镇痛时间更长,差异有均有统计学意义[WMD=12.79,95%CI(10.96,14.62),P<0.00001;WMD=12.10,95%CI(-6.76,6.86),P<0.00001;WMD=11.90,95%CI(9.17,14.63),P<0.00001]。结论由于样本量较小、纳入研究方法学质量不高,布比卡因与新斯的明联用进行骶管阻滞延长小儿尿道下裂术后镇痛时间的作用尚不能完全肯定,加之新斯的明用量仍不明确,因此仍需更多大样本的随机双盲对照试验进一步评价。Objective To assess the analgesic effect of caudal bupivacaine with neostigmine for hypospadias surgery in children. Methods We searched The Cochrane Library （Issue 2, 2008）, MEDLINE （1966-2008）, EMbase （1980-2008）, CBMdisc （1978-2008）, CNKI （1989-2008） and Wanfang Database using the keywords ＂bupivacaine＂, ＂neostigmine＂ and ＂hypospadias＂ to identify randomized control trials （RCTs） of caudal bupivacaine with neostigmine versus bupivacaine alone for hypospadias surgery in children. The methodological quality of included RCTs was evaluated by two reviewers independently, and Meta-analysis was conducted using RevMan 5.0.13 software. Results We identified 3 RCTs including 160 patients which had an uncertain risk of bias. The results of meta-analysis showed no significant difference found between bupivacine alone and bupivacine plus 1 μg/kg neostigmine （WMD= 0.05, 95%CI -6.76 to 6.86, P= 0.99）, but a difference was found between bupivacine alone and bupivacine plus 1μg/kg, 2μg/kg, or 3μg/kg neostigmine （WMD= 12.79, 95%CI 10.96 to 14.62, P〈 0.000 01; WMD= 12.10, 95%CI -6.76 to 6.86, P〈 0.000 01; WMD= 11.90, 95%CI 9.17 to 14.63, P〈0.000 01）. The duration of postoperative analgesia of the bupivacaine with neostigmine group was longer than that of bupivacine alone. Conclusions Because of the small sample size and the unclear risk of bias in the included RCTs, the effectiveness of caudal bupivacaine with neostigmine for postoperative pain management after hypospadias surgery in children is not completely confirmed. So more large sample size, double-blind RCTs are needed.

关 键 词：布比卡因 新斯的明 尿道下裂 系统评价 

分 类 号：R726.1[医药卫生—儿科]