股神经阻滞用于全膝关节置换术术后镇痛安全性的系统评价再评价  

Safety of femoral nerve block for postoperative analgesia of total knee arthroplasty:an overview of 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5期522-528,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的对股神经阻滞(FNB)用于全膝关节置换术(TKA)术后镇痛安全性的系统评价进行再评价。方法计算机检索The Cochrane Library,Pub Med,EMbase,CNKI、Wan Fang Data和VIP数据库,检索时限均为建库截至2016年7月。由2位研究者按照纳入与排除标准筛选文献,提取资料。纳入研究的方法学质量评价采用AMSTAR进行。采用术后恶心呕吐、嗜睡、尿潴留、头晕、瘙痒、低血压、跌倒、静脉血栓、深部感染发生率作为主要评价指标对FNB用于TKA术后镇痛的安全性进行再评价。结果共纳入12个系统评价,分别评价了FNB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)、阿片类药物静脉自控镇痛(PCA)、收肌管阻滞(ACB)相比较的安全性。AMSTAR评价结果显示系统评价的质量均一般,得分范围为3~10分。系统评价再评价结果显示:FNB术后恶心呕吐发生率低于EA和PCA,但高于ACB。FNB术后嗜睡发生率低于PCA。FNB术后尿潴留发生率低于EA和PCA。FNB术后头晕发生率低于EA和PCA。FNB术后低血压发生率低于EA。结论当前证据显示,FNB用于TKA术后镇痛安全性优于EA和PCA。受纳入研究数量和质量的限制,本研究结论尚需要更多研究予以验证。Objectives To overview the systematic reviews/meta-analyses of safety of femoral nerve block （FNB） used as a postoperative analgesic technique in patients undergoing total knee arthroplasty （TKA）. Methods We searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, and VIP from inception to July, 2016. Two reviewers independently screened literature, extracted data and used AMSTAR to evaluate the methodological quality of the included studies. The major indexes used to evaluate the safety of FNB were the incidence rates of symptoms including nausea, vomiting, sedation, retention of urine, dizziness, pruritus, hypotension, fails, nenous thromboembolism and deep infection. Results A total of 12 systematic reviews/meta-analyses were included.They assessed the safety of FNB compared with local infiltration analgesia （LIA）, periarticular multimodal drug injection （PMDI）, epidural analgesia （EA）, patient-controlled intravenous analgesia of opioids （PCA） and adductor canal block （ACB）, respectively. The methodological quality of included studies were medium, with the scores between 3 to 10. The results of overview indicated that： FNB had lower incidence rates of nausea and vomiting compared with EA and PCA, but had higher than ACB. FNB had lower incidence rates of sedation and retention of urine compared with EA and PCA. FNB had lower incidence rates of dizziness compared with EA and PCA, and lower incidence rate of hypotension compared with EA. Conclusion Current evidence suggests that FNB is safer than EA and PCA. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.

关 键 词：股神经阻滞 阿片类药物静脉患者自控镇痛 局部浸润镇痛镇痛 收肌管阻滞 全膝关节置换术 系统评价再评价 

分 类 号：R614[医药卫生—麻醉学]