布洛芬用于儿童和青少年骨折镇痛的效果和安全性：系统评价和Meta分析  

The analgesic effect and safety of ibuprofen on the children and adolescents with fracture： systematic review and Meta- analysis

作　　者：张广源[1] 索生红[2] 杨森林 Zhang Guangyuan;Suo Shenghong;Yang Senlin(Department of Joint,the Affiliated Hospital of Qinghai University,Xining 810100,China;Department of Clinical Medicine,Qinghai Health Vocational and Technical College,Xining 810100,Chin)

机构地区：[1]青海大学附属医院关节科,西宁810100 [2]青海卫生职业技术学院临床医学系,西宁810100

出　　处：《国际麻醉学与复苏杂志》2018年第7期650-657,共8页International Journal of Anesthesiology and Resuscitation

摘　　要：目的对比其他镇痛药评价布洛芬对儿童和青少年骨折镇痛效果、副作用和骨折愈合的影响。方法系统检索Medline、EMBASE、the Cochrane Library、Web of Science、CBM、CNKI和万方数据库。两名研究人员独立筛选文献、提取数据、评价纳入研究的偏倚风险。根据异质性检验结果选择随机效应模型或固定效应模型合并数据。结果共纳入6项研究，1 225名患者。纳入研究的研究设计科学合理、实施过程严谨规范。与其他镇痛药相比，服药0.5 h后布洛芬的镇痛效果较差[标准平均差（standard mean difference, SMD）=-0.25，95%CI：-0.48--0.02，P〈0.05）]，但服药1 h及2 h后布洛芬的镇痛效果更佳（SMD=0.61，95%CI：0.03-1.19，P=0.04；SMD=0.88，95%CI：0.57-1.18，P〈0.05），而两组在镇痛失败的比例上差异无统计学意义[相对危险度（relative risk, RR）=0.83，95%CI：0.64-1.08，P〉0.05）]。在副作用方面，布洛芬组的总副作用、恶心、呕吐和瞌睡的发生率均明显低于其他镇痛药组（P〈0.05）。在骨折愈合方面，布洛芬和其他镇痛药的影响差异无统计学意义（RR=0.99，95%CI：0.18-5.55，P〉0.05）。结论服药1 h后和2 h后布洛芬的镇痛效果明显优于其他镇痛药，总副作用、恶心、呕吐和瞌睡的发生率也明显低于其他镇痛药；而布洛芬和其他镇痛药对儿童和青少年骨折愈合的影响差异无统计学意义。Objective To compare ibuprofen with other analgesics in analgesic efficacy, incidence of adverse events and fracture healing in the child and adolescent fracture patients.Methods A systematic search of 7 databases, including Medline（via PubMed）, EMBASE, Cochrane Library, Web of Science, CBM, CNKI and Wanfang, was performed. Two independent reviewers identified the eligible studies, extracted the data, and evaluated the risk of bias of the included studies. We chose the randomized or fixed effect model to synthesize the data based on the result of heterogeneity test.Results We included six studies with 1 225 patients. Compared to other analgesics, the analgesic effect of ibuprofen was less satisfying half an hour after drug administration[standard mean difference（SMD）=-0.25, 95%CI：-0.48--0.02, P〈0.05], but was more effective between 1-2 h after drug administration（SMD=0.61, 95%CI： 0.03-1.19, P〈0.05, SMD=0.88, 95%CI： 0.57-1.18, P〈0.05, respectively）, while there was no difference in the analgesic failure between ibuprofen and other analgesics[relative risk（RR）=0.83, 95%CI： 0.64-1.08, P〉0.05]. The incidence of total adverse events, including nausea, vomiting and drowsiness, in the ibuprofen group was lower than that in other analgesics group. The influence of ibuprofen on fracture healing did not differ from that of other anesthetics（RR=0.99, 95%CI： 0.18-5.55, P〉0.05）.Conclusions Ibuprofen displayed a better analgesic effect between 1-2 h after drug administration than other analgesics. It also reduced the incidence of total adverse events, relative to other analgesics. The effect of ibuprofen on fracture healing did not differ from other analgesics in child and adolescent patients.

关 键 词：布洛芬 儿童 骨折 镇痛 

分 类 号：R726.1[医药卫生—儿科]