保护性镇痛对截肢后幻肢痛发生率影响的Meta分析  

Effect of Protective Analgesia on Incidence of Phantom Limb Pain after Amputation:A Meta-analysis

作　　者：熊巍[1,3] 张军卫[2,3] 王增春[1,3] 任自刚[1,3] 王强[1,3] XIONG Wei;ZHANG Jun-wei;WANG Zeng-chun;REN Zi-gang;WANG Qiang(Department of Anesthesiology,Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China;Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China;Capital Medical University School of Rehabilitation Medicine,Beijing 100068, China)

机构地区：[1]中国康复研究中心北京博爱医院,麻醉科,北京市100068 [2]中国康复研究中心北京博爱医院,脊柱脊髓外科,北京市100068 [3]首都医科大学康复医学院,北京市100068

出　　处：《中国康复理论与实践》2017年第12期1450-1458,共9页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的系统评价保护性镇痛对截肢后幻肢痛发生率的影响。方法检索建库至2017年6月Cochrane Library、PubMed、Embase、Web of Science、OVID、Science Direct数据库,收集围术期保护性镇痛防治截肢后幻肢痛的临床研究进行评价。由两位独立研究人员根据纳入与排除标准筛选文献并进行质量评价后,提取文献中的相关资料,包括一般资料和幻肢痛发生率,利用RevMan 5.3软件进行Meta分析。结果最终筛选出6篇符合条件的文献。术后随访1个月期共纳入256例患者,其中对照组129例,实验组127例。术后随访6个月期共纳入232例患者,其中对照组118例,实验组114例。术后随访12个月期共纳入118例患者,其中对照组60例,实验组58例。采用围术期保护性镇痛方式进行干预后术后1个月[RD=-0.21,95%CI(-0.38,-0.04),Z=2.47,P=0.01]和术后6个月[RD=-0.28,95%CI(-0.52,-0.05),Z=2.37,P=0.02]的幻肢痛发生率低于对照组,而术后12个月的幻肢痛发病率两组之间无显著性差异[RD=-0.20,95%CI(-0.48,0.09),Z=1.35,P=0.18]。结论围术期保护性镇痛能够预防截肢后近期和中期幻肢痛的发生率,但远期效果需要做进一步观察。Objective To systemically evaluate the effect of protective analgesia on preventing phantom limb pain(PLP)after amputation.Methods Published articles from the earliest date available to June,2017were recalled from Cochrane Library,PubMed,Embase,Web of Science,OVID,and Science Direct to collect prospective studies using protective analgesia in perioperative period to prevent PLP after amputation.Two reviewers screened literatures referring to studies according to the inclusion and exclusion criteria,and assessed the quality of them.Data of general information and incidence of PLP in the follow-up period were extracted and analyzed with RevMan5.3software.Results Six studies were included with a total of256patients in the one-month follow-up period including127cases in the protective analgesia group(group P)and129cases in the control group(group C),a total of232patients in the six-month follow-up period including114cases in group P and118cases in group C,and a total of118patients in the twelve-month follow-up period including58cases in group P and60cases in group C.The incidence of PLP were lower in group P than those in group C in the one-month follow-up period(RD=-0.21,95%CI[-0.38,-0.04],Z=2.47,P=0.01)and in the six-month follow-up period(RD=-0.28,95%CI[-0.52,-0.05],Z=2.37,P=0.02),and it was not significant in the twelve-month follow-up period(RD=-0.20,95%CI[-0.48,0.09],Z=1.35,P=0.18).Conclusion Protective analgesia in perioperative period can prevent against PLP after amputation in the recent time,however,it needs further observation in long-term.

关 键 词：围术期 保护性镇痛 截肢 幻肢痛 前瞻性研究 META分析 

分 类 号：R687.5[医药卫生—骨科学]