超声引导腰方肌阻滞与腹横肌平面阻滞用于下腹部手术后镇痛效果的比较:meta分析  

Efficacy of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block for analgesia after lower abdominal surgery:a meta-analysis

作　　者：郝泉水 孙思华 李先超 胡亮[1] 张慧[1] 吴耀华[1] Hao Quanshui;Sun Sihua;Li Xianchao;Hu Liang;Zhang Hui;Wu Yaohua(Department of Anesthesiology,Huanggang Central Hospital,Huanggang 438000,Hubei Province,China;Department of Anesthesiology,Qichun People's Hospital,Qichun 435300,Hubei Province,China)

机构地区：[1]湖北省黄冈市中心医院麻醉科,438000 [2]湖北省蕲春县人民医院麻醉科,435300

出　　处：《中华麻醉学杂志》2019年第11期1326-1329,共4页Chinese Journal of Anesthesiology

基　　金：湖北省卫生计生科研基金资助(WJ2016-YZ-11);黄冈市科技计划项目(XQYF2019000014)。

摘　　要：目的采用meta分析比较超声引导腰方肌阻滞(QLB)与腹横肌平面阻滞(TAPB)用于下腹部手术后镇痛的效果。方法计算机检索Pubmed、Embase、The Cochrane Library、ISI Web of knowledge、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库及万方数据库,检索时限均为建库至2019年5月。纳入采用超声引导下QLB与TAPB用于下腹部手术后镇痛的随机对照研究文献。主要指标:术后各时点静态及动态VAS评分;次要指标:不良反应(恶心呕吐、眩晕、皮肤瘙痒)发生率。两位研究者按照纳入标准筛选文献、提取资料,按照Cochrane系统评价员手册5.1.0推荐的相关标准,两位评价员独立对纳入文献的质量进行评价,采用RevMan 5.3进行meta分析。结果共纳入16项随机对照研究,共1218例患者,其中QLB组608例,TAPB组610例。meta分析结果显示:与TAPB组相比,QLB组术后2、4、6、12和24 h时静态VAS评分降低,术后8、12 h时动态VAS评分降低,恶心呕吐发生率降低(P<0.05)。结论与TAPB相比,QLB能提供更好的术后早期镇痛效果,且不良反应发生风险较低。Objective To systematically review and compare the efficacy of ultrasound-guided quadratus lumbosum block(QLB)and transverse abdominis plane block(TAPB)for analgesia after lower abdominal surgery.Methods Pubmed,Embase,The Cochrane Library,ISI Web of knowledge,Chinese biomedical literature database,Chinese science and technology journal full-text database,Chinese journal full-text database and Wanfang database were searched by a computer from the date of database establishment up to May 2019.Randomized controlled trials involving the efficacy of ultrasound-guided QLB and TAPB for analgesia after lower abdominal surgery were included in this study.The primary outcome was visual analog scale scores at rest and during activity at each time point after operation,and the secondary outcome was the incidence of adverse reactions(nausea and vomiting,dizziness,pruritus).The two researchers selected the literature and extracted the data according to the inclusion criteria,independently evaluated the quality of the included literature according to the relevant criteria recommended in Cochrane reviewers′manual 5.1.0,and conducted a meta-analysis using RevMan 5.3.Results A total of 16 randomized controlled studies involving 1218 patients were included,including 608 cases in QLB group and 610 cases in TAPB group.The results of meta-analysis showed that the visual analog scale scores at rest at 2,4,6,12 and 24 h after surgery and during activity at 8 and 12 h after surgery and the incidence of nausea and vomiting were significantly decreased in QLB group as compared with TAPB group(P<0.05).Conclusion QLB can provide better early postoperative analgesia than TAPB with a lower risk of adverse reactions.

关 键 词：神经传导阻滞 腰肌 腹肌 镇痛 META分析 

分 类 号：R614[医药卫生—麻醉学]