腹部外科术后连续腹横肌平面阻滞与患者自控静脉镇痛对比的Meta分析  

Continuous transversus abdominis plane block versus patient-controlled intravenous analgesia after abdominal surgery:A systematic review and Meta-analysis

作　　者：李东明 杨鋆 王宇凡 王皓 冯哲文 杨盈赤[1] 金岚[1] 张忠涛[1] Li Dongming;Yang Yun;Wang Yufan;Wang Hao;Feng Zhewen;Yang Yingchi;Jin Lan;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Center of General Surgery,National Clinical Research Center for Digestive Disease,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,国家消化系统疾病临床医学研究中心普外分中心,100050 [2]首都医科大学附属北京友谊医院临床流行病学与循证医学室,国家消化系统疾病临床医学研究中心方法学平台,100050

出　　处：《国际外科学杂志》2021年第4期226-232,F0003,共8页International Journal of Surgery

基　　金：国家科技支撑计划课题(2015BAI13B09);国家重点研发计划(2017YFC0110904);北京市属医院科研培育计划(PX2020004);首都医科大学附属北京友谊医院院启动课题(YYQDKT2018-4)。

摘　　要：目的比较连续腹横肌平面阻滞(CTAP)与患者自控静脉镇痛(PCIA)在腹部外科术后的安全性及有效性。方法以"连续腹横肌平面阻滞,连续腹横筋膜阻滞,病人自控镇痛,continuous/modified,transversus/transverse abdominis plane block,TAP block,patient controlled analgesia,patient-controlled analgesia,patient controlled intravenous analgesia,patient-controlled intravenous analgesia,PCA/PCIA/IV-PCA"等为检索关键词,检索PubMed、Embase、Web of Science、CNKI等数据库从建库以来至2021年2月的中英文文献。按照镇痛治疗方法分为连续腹横肌平面阻滞组(CTAP组)及患者自控静脉镇痛组(PCIA组)。使用Review Manager 5.4软件,对腹部外科术后恶心呕吐、头晕、疼痛评分、康复情况等结局指标进行Meta分析。计数资料使用风险比(RR)合并统计量,计量资料使用均数±标准差(Mean±SD)合并统计量。使用I2评价研究的异质性,使用固定效应模型或随机效应模型进行数据分析。结果(1)文献检索结果:纳入6项随机对照试验,其中英文研究2篇,中文研究4篇,共包括479例患者。(2)Meta分析结果:与PCIA组相比,CTAP组术后恶心呕吐(RR=0.22,95%CI:0.08~0.62,P<0.01)、头晕(RR=0.27,95%CI:0.09~0.79,P=0.02)不良反应发生率较低,术后24 h(MD=-0.75,95%CI:-1.42~-0.08,P=0.03)、48 h(MD=-0.68,95%CI:-1.05~-0.31,P<0.001)活动状态时的疼痛评分较低,术后首次下床活动时间(MD=-0.49,95%CI:-0.69~-0.30,P<0.001)和首次排气时间(MD=-10.47,95%CI:-13.53~-7.41,P<0.001)较早,差异有统计学意义。但两组术后24 h(MD=-0.25,95%CI:-0.57~0.08,P=0.14)、48 h(MD=-0.15,95%CI:-0.39~0.09,P=0.22)静息状态时的疼痛评分及住院时间(MD=-1.01,95%CI:-2.28~0.26,P=0.12)差异无显著统计学意义。结论连续腹横肌平面阻滞是一种较为安全有效的镇痛方式,更符合加速康复外科理念,可推荐其作为一种患者自控静脉镇痛的替代方法。Objective To compare the safety and efficacy of continuous transversus abdominis plane(CTAP)block and patient-controlled intravenous analgesia(PCIA)in abdominal surgery postoperatively.Methods PubMed,Embase,Web of Science,CNKI and other English and Chinese databases were searched since their establishment to February 2021 with"continuous/modified,transversus/transverse abdominis plane block,TAP block,patient controlled analgesia,patient-controlled analgesia,patient controlled intravenous analgesia,patient-controlled intravenous analgesia,PCA/PCIA/IV-PCA"as the search keywords.According to the analgesia treatment methods,patients were divided into continuous transversus abdominis plane block group(CTAP group)and patient-controlled intravenous analgesia group(PCIA group).Review Manager 5.4 software was used to conduct a Meta-analysis on outcome indicators such as postoperative nausea and(or)vomiting(PONV),dizziness,pain score and recovery status after abdominal surgery.Risk ratio(RR)was calculated for counting data,Mean±SD was calculated for measurement data.Heterogeneity was measured by I2,and related data were analyzed by using either a fixed effects model or a random effects model.Results(1)The results of literature search:A total of 6 randomized controlled trials,including 2 published in English and 4 published in Chinese were analyzed,involving 479 patients.The results of the Meta-analysis:Compared with PCIA,CTAP block had lower incidence of PONV(RR=0.22,95%CI:0.08-0.62,P<0.01),lower incidence of dizziness(RR=0.27,95%CI:0.09-0.79,P=0.02),lower pain scores on movement at 24 h(MD=-0.75,95%CI:-1.42--0.08,P=0.03)and 48 h(MD=-0.68,95%CI:-1.05--0.31,P<0.001)postoperatively,and earlier time of first mobilization(MD=-0.49,95%CI:-0.69--0.30,P<0.001)and first exhaust(MD=-10.47,95%CI:-13.53--7.41,P<0.001),with statistically significant differences.However,there were no statistically significant differences in pain scores at rest at 24 h(MD=-0.25,95%CI:-0.57-0.08,P=0.14)and 48 h(MD=-0.15,95%CI:-0.39-0.09,P=0.22)postopera

关 键 词：腹部 外科手术 神经传导阻滞 META分析 镇痛 病人控制 加速康复外科 

分 类 号：R614[医药卫生—麻醉学]