体外冲击波碎石术中不同镇痛药物效果的网状Meta分析  

Network Meta-analysis comparing the efficacy of different analgesics in extracorporeal shock wave lithotripsy

作　　者：单刚[1] 赵俊华[1] 张珩 田野[1] 安凌悦 罗光恒 Shan Gang;Zhao JunHua;Zhang Heng;Tian Ye;An Lingyue;Luo Guangheng(Department of Urology,Guizhou Provincial People’s Hospital,Guiyang 550002,China;Department of Biomedical Sciences,Medical College of Guizhou University,Guiyang 550025,China;Department of Urology,First Affiliated Hospital of Guangzhou Medical University,Guangzhou 511436,China)

机构地区：[1]贵州省人民医院泌尿外科,贵阳550002 [2]贵州大学医学院生物医学系,贵阳550025 [3]广州医科大学附属第一医院泌尿外科,511436

出　　处：《中华泌尿外科杂志》2020年第12期936-941,共6页Chinese Journal of Urology

摘　　要：目的:比较不同镇痛药物在体外冲击波碎石术(ESWL)中的止痛效果。方法:计算机检索Ovid、Pubmed、Embase、CINAHL、中国知网、万方数据库。搜索有关ESWL术中镇痛药物镇痛效果的随机对照研究,检索时间为建库至2019年6月30日。文献纳入标准:对门诊行ESWL的≥18岁上尿路结石患者,使用单一用药或与对照组相同的基础用药,伴或不伴术中疼痛追加镇痛用药,对照组采取安慰剂或其他药物镇痛;给药方式为静脉注射、肌肉注射、局部浸润或表面涂抹;结局指标为疼痛视觉模拟评分(VAS)。排除标准:研究对象有药物滥用史或<18岁;数据不完整或无法提取数据的研究。由2名研究员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用STATA 14.0和WinBugs 1.43软件对数据进行网状Meta分析,比较ESWL术中使用不同镇痛药物患者的VAS。结果:最终纳入17篇随机对照研究,共包含1427例患者。17篇文献质量等级均为B级,漏斗图评估结果显示均无发表偏移。网状Meta分析的两两比较结果显示,强效阿片类、非甾体类、局麻类、弱效阿片类、安慰剂之间镇痛效果差异有统计学意义(95%CI均不包含0)。网状Meta分析镇痛效果排序由强至弱依次为强效阿片类、非甾体类、局麻类、弱效阿片类,排序概率分别为0.7719、0.7657、0.4141、0.4059、0.1425。结论:在ESWL术中,强效阿片类、非甾体类、局麻类、弱效阿片类药物与安慰剂比较,均可以取得良好的镇痛效果。镇痛效果由强至弱依次为强效阿片类、非甾体类、局麻类、弱效阿片类。Objective To compare the efficacy of different analgesics in extracorporeal shock wave lithotripsy(ESWL)by network meta-analysis.Methods Databases including the Ovid,Pubmed,Embase,CIN-AHL,CNKI,Wanfang data were searched for relevant clinical randomized controlled trials(RCTs)comparing the efficacy of different analgesics in ESWL from inception to June 30th 2019.Inclusion criteria involved the ESWL on out patients with urinary stones at least 18 years of age,using a single drug or the same medication as the control group,with or without intraoperative additional pain medication,the control group taking placebo or other,pain medication,drug delivery methods including intravenous,intramuscular,local invasion or the smear,and using visual analog pain score(VAS)as outcome indicator.Exclusion criteria involved the subjects in the studies had a history of drug abuse or were younger than 18 years of age,and data were incomplete or could not be extracted.Two reviewers dependently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was then performed by using Stata 13.0 and WinBugs 1.43 software to compare VAS of patients with different analgesics during ESWL.Result A total of 17 RCTs involving 1427 patients were included.All of included articles is indicated B of quality grade after the quality inspection.The funnel plot was used to evaluate the publication offset test and indicate no publication offset.The pairwise comparison results of network Meta-analysis showed that there were statistically significant differences in analgesic effects between strong opioids,non-steroids,local anesthesia,weak opioids,and placebo(95%confidence interval does not include 0).The results of network Meta-analysis showed that the order of analgesic effect in extracorporeal shock wave lithotripsy starting from the best was potent opioids,NSAIDS,EMLA and weak opioids(ranking probability:0.7719,0.7657,0.4141,0.4059,0.1425).Conclusion Potent opioids,NSAIDS,EMLA and weak opioids can achieve good anal

关 键 词：碎石术 体外冲击波碎石术 镇痛 网状Meta分析 

分 类 号：R699[医药卫生—泌尿科学]