国人局部麻醉与硬膜外麻醉对腹股沟疝无张力修补术影响的Meta分析  

Domestic Tension Free Inguinal Hernia Repair with Local Anesthesia and Epidural Anesthesia: A Meta Analysis

作　　者：刘少杰[1,2] 任镜清[1,2] 唐嘉慧 杨小红[1,2] 朱宣进[1,2] 

机构地区：[1]暨南大学医学院附属广州红十字会医院胃肠外科,广州510220 [2]暨南大学医学院附属广州红十字会医院创伤外科研究所,广州510220

出　　处：《循证医学》2014年第3期166-171,共6页The Journal of Evidence-Based Medicine

基　　金：广东省科技计划资助项目(2012A030400036)

摘　　要：目的比较局部麻醉和硬膜外麻醉下行腹股沟疝无张力修补术的疗效。方法检索PubMed、EMBASE、MEDLINE、中国学术期刊网全文数据库收录的公开发表与研究目的相关的临床随机对照研究,纳入符合条件的研究,对数据进行Meta分析。评价指标包括手术时间、住院时间、治疗费用、术后伤口疼痛发生率及术后复发率。结果有19个研究,共4 516例患者纳入分析,局麻组2 330例,硬膜外麻醉组2 186例。Meta分析显示,局麻组在手术时间[加权均数差-5.36 min,95%可信区间(-5.67,-5.06)min,P<0.000 01]、住院时间[加权均数差-2.82 d,95%可信区间(-2.89,-2.75)d,P<0.000 01]、治疗费用[加权均数差-998.83元,95%可信区间(-1 004.96,-992.71)元,P<0.000 01]、术后疼痛发生率[优势比0.67,95%可信区间(0.49,0.91),P=0.01]方面优于硬膜外麻醉组,两组复发率无明显差异[危险比1.28,95%可信区间(0.54,3.01),P=0.58]。结论与硬膜外麻醉相比,局麻下行腹股沟无张力疝修补术具有手术时间短、住院时间短、费用低、术后疼痛轻的优点,两种麻醉方法对术后复发率无影响。Objective To evaluate the effects of local anesthesia and epidural anesthesia in tension free inguinal hernia repair. Methods Electronic databases including PubMed, EMBASE, MEDLINE, Chinese Academic Journal Full- text Database were searched to identify randomized controlled trials （RCTs） that reported the effects of local anesthesia and epidural anesthesia in tension free inguinal hernia repair. Evaluation indicators were included： operation time, length of hospital stay, cost, rate of wound pain and recurrence. Results There are 19 RCTs, 4 516 patients included in the meta analysis, 2 330 cases in local anesthesia group and 2 186 cases in epidural anesthesia group. Meta analysis indicated that operation time [WMD=-5.36 rain, 95%CI （-5.67, -5.06） min, P〈0.000 01], length of hospital stay [WMD= -2.82 d, 95%CI （-2.89, -2.75）d, P〈0.000 01], cost [WMD=-998.83 yuan, 95%CI （-1 004.96, -992.71） yuan, P〈0.000 01], and rate of wound pain [OR=0.67, 95%CI （0.49, 0.91）, P=0.01] in local anesthesia group were better than those in epidural group. But recurrence was not significant differences[RR=1.28, 95%CI （0.54, 3.01）, P= 0.58]. Conclusion Compare to epidural anesthesia, tension free inguinal hernia repair with local anesthesia has the merit of shorter operation time, shorter length of hospital stay, lower cost, less wound pain and the same recurrence.

关 键 词：腹股沟疝 麻醉 META分析 

分 类 号：R614[医药卫生—麻醉学] R656.22[医药卫生—外科学]