股神经阻滞用于全膝关节置换术术后镇痛有效性的系统评价再评价  

The efficacy of femoral nerve block for postoperative analgesia of total knee replacement:an overview of the systematic reviews

作　　者：程序[1] 郑琳莉 徐毅[1] 吴佳慧[1] 张文胜[1,3] 

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]四川大学华西临床医学院,成都610041 [3]四川大学华西医院转化神经科学中心麻醉与危重急救研究室,成都610041

出　　处：《中国循证医学杂志》2017年第3期283-290,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的对股神经阻滞(femoral nerve block,FNB)用于全膝关节置换术(total knee replacement,TKR)术后镇痛有效性的系统评价进行再评价。方法计算机检索The Cochrane Library、PubMed、EMbase、CNKI、WanFang Data和VIP数据库,纳入股神经阻滞用于全膝关节置换术术后镇痛有效性的系统评价,检索时限均为建库至2016年7月。由2位研究者按纳入与排除标准筛选文献,提取资料。纳入系统评价的方法学质量评价采用AMSTAR进行评价。采用术后疼痛评分和阿片类药物使用量作为主要评价指标对其镇痛有效性进行再评价。结果共纳入了16个系统评价,分别评价了股神经阻滞和局部浸润镇痛(LIA)、关节周围镇痛药物注射(PMDI)、硬膜外镇痛(EA)、静脉阿片类药物患者自控镇痛(PCA)、收肌管阻滞(ACB)相比较的有效性。纳入系统评价的方法学质量结果显示系统评价的质量均一般,评分范围为3~9分。纳入的系统评价术后疼痛评分结果显示:静息时,股神经阻滞在术后6 h的镇痛效果并不优于局部浸润镇痛的效果,但在术后12 h,其镇痛效果优于关节周围镇痛药物注射;其效果在术后24 h优于静脉阿片类药物患者自控镇痛和局部浸润镇痛,但不优于收肌管阻滞镇痛效果。在运动时,股神经阻滞在术后24 h镇痛效果优于静脉阿片类药物患者自控镇痛和局部浸润镇痛效果,其在术后48 h镇痛效果优于静脉阿片类药物患者自控镇痛。在阿片类药物使用量方面,股神经阻滞镇痛在术后12 h时使用阿片类药物量多于局部浸润镇痛,而其在术后24 h时阿片类药物量少于静脉阿片类药物患者自控镇痛和局部浸润镇痛,其在术后48 h时使用阿片类药物量也少于静脉阿片类药物患者自控镇痛和收肌管阻滞。股神经阻滞在患者满意度方面优于收肌管阻滞、硬膜外镇痛和静脉阿片类药物患者自控镇痛。结论本研究结果显示股神经阻滞用于全膝关�Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNB vs. LIA,PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews＇ results showed that： at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients＇ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.

关 键 词：股神经阻滞 全膝关节置换术 系统评价 系统评价再评价 

分 类 号：R614[医药卫生—麻醉学]