盐酸曲马多联合芬太尼用于术后患者静脉自控镇痛效果和安全性的Meta分析  

Efficacy and safety of tramadol combined with fentanyl in patient-controlled intravenous analgesia： a Meta analysis

作　　者：李鹏[1] 王珊珊[1] 陈富超[1] 黄麟杰[1] 朱军[1] 

机构地区：[1]湖北医药学院附属东风医院药学部,湖北省十堰市442008

出　　处：《中国医药》2015年第7期1042-1046,共5页China Medicine

摘　　要：目的 评价盐酸曲马多联合芬太尼用于术后患者静脉自控镇痛（PCIA）的临床效果与安全性.方法 计算机检索PubMed、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库和万方医学数据库,收集盐酸曲马多联合芬太尼术后PCIA的随机对照试验（RCT）,采用RevMan 5.2软件对疼痛视觉模拟量表（VAS）评分、Ramsay评分、安全性进行Meta分析.结果 共纳入17个RCT,共1 440例患者.Meta分析结果显示：与单用芬太尼组比较,盐酸曲马多联合芬太尼组术后12、24及48 h VAS评分差异无统计学意义（P＞0.05）;术后12 h Ramsay评分升高,差异有统计学意义[加权均数差（WMD）=0.22,95％置信区间（CI）：0.05 ～0.40,P=0.01].与单用盐酸曲马多组比较,盐酸曲马多联合芬太尼组术后12 h VAS评分降低[WMD=-0.50,95％CI：-0.80 ～-0.20,P＜0.01];术后12、24、48 h Ramsay评分2组比较,差异均无统计学意义（P＞0.05）.盐酸曲马多联合芬太尼组术后恶心呕吐发生率是单用芬太尼组的0.51倍,差异有统计学意义[比值比=0.51,95％ CI：0.28 ～0.91,P=0.02],是单用盐酸曲马多组的0.29倍,差异有统计学意义[比值比=0.29,95％ CI：0.18 ～0.47,P＜0.01].结论 盐酸曲马多联合芬太尼用于术后PCIA均能获得良好的镇痛镇静效果,患者术后不良反应的发生率降低,临床应用更安全.Objective To evaluate the efficacy and safety of tramadol combine with fentanyl in patientcontrolled intravenous analgesia （PCIA）.Methods The randomized controlled trials （RCT） regarding PCIA using tramadol combined with fentanyl were retrieved from PubMed,the Cochrane Library,Chinese Biomedical Literature Database （CBM）,China National Knowledge Infrastructure （CNKI） and WanFang Data.RevMan 5.2 software was applied for Meta-analysis of visual analog scale （VAS） score,Ramsay score and safety of tramadol combined with fentanyl in PCIA.Results A total of 10 RCTs involving 1440 patients were included.There were no significant differences in VAS score at 12 h,24 h and 48 h after operation between fentanyl group and tramadol combined with fentanyl group;compared with that in tramadol group,the VAS at 12 hour after operation was decreased in tramadol combined with fentanyl group [weighted mean difference （WMD） =-0.5,95% CI：-0.80,-0.20,P 〈0.01].Compared with that in fentanyl group,the Ramsay score at 12 hour after operation was decreased in tramadol combined with fentanyl group [WMD =0.22,95% CI：0.05,0.40,P =0.01],but there were no significant differences of Ramsay score at 12,24 and 48 hour after operation between tramadol group and tramadol combined with fentanyl group.The incidence of nausea and vomiting in tramadol combined with fentany1 group was significantly decreased compared with that in fentanyl group [OR =0.51,95 % CI：0.28,0.91,P =0.02] and tramadol group [OR =0.29,95% CI：0.18,0.47,P 〈 0.01].Conclusion Tramadol combined with fentanyl has better analgesic effect in PCIA compared with tramadol or fentanyl alone.

关 键 词：盐酸曲马多 芬太尼 静脉自控镇痛 META分析 

分 类 号：R593[医药卫生—内科学]