膝关节镜术后关节腔和硬膜外镇痛的Meta分析  

Meta-analysis on intra-articular and intra-epidural analgesia following arthroscopic knee surgery

作　　者：庞辉[1] 蔡晓琳[2] 张馨心 林调 Pang Hui;Cai Xiaolin;Zhang Xinxin;Lin Tiao(Deptment of Medical Records Management, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;Department of Musculoskeletal Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China;Sun Yat-sen University Zhongshan School of Medicine, Guangzhou 510080, China)

机构地区：[1]中山大学附属第一医院病案管理科,广州510080 [2]中山大学附属第一医院骨肿瘤科,广州510080 [3]中山大学中山医学院,广州510080

出　　处：《中华关节外科杂志（电子版）》2021年第5期572-577,共6页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的评价关节腔内(IA)和硬膜外注射(IE)吗啡镇痛对膝关节镜术后的镇痛效果与安全性。方法检索电子数据库PubMed、Excerpta Medica Database(Embase)、万方数据库和中国知网(CNKI),并追溯纳入文献的相关参考文献,收集比较膝关节镜手术患者术后应用IA和IE途径注射吗啡镇痛的随机对照试验(RCTs),并排除镇痛药物含有其他配方麻药,或纳入患者患有精神疾病、术前服用镇静、镇痛药物的相关试验,对最终纳入的文献进行质量评价和资料提取,而后采用RevMan 5.2软件进行统计分析。结果纳入6个RCTs,包括319例患者,IA患者159例,IE患者160例。术后8 h,24 h,IA与IE组患者痛觉视觉模拟评(VAS)对比均无明显差异[8 h:加权均数差(WMD)=-0.01,95%可信任区间(CI)(-0.16,0.14),P=0.89;24 h:WMD=-0.25,95%CI(-0.54,0.03),P=0.08]。但IA组与IE组比较,显著减少副作用发生风险[恶心呕吐:优势比(OR)=0.11,95%CI(0.02,0.48),P=0.003;皮肤瘙痒:OR=0.11,95%CI(0.03,0.37),P=0.0003;尿潴留:OR=0.07,95%CI(0.02,0.25),P<0.0001]。按照吗啡剂量划分的亚组分析提示,吗啡剂量对上述结果无明显影响。结论膝关节镜术后通过IA与IE注射吗啡镇痛相比,镇痛效果无明显差异,但IA组副作用发生率显著低于IE组,具临床应用优势。Objective To compare the efficacy and safety of intra-articular(IA)and intra-epidural(IE)analgesia by morphine after arthroscopic knee surgery.Methods A literature search was conducted in PubMed,Excerpta Medica Database(Embase)、WANFANG Data and China National Knowledge Infrastructure(CNKI).Further searches for articles were conducted by checking all references describing IA and IE analgesia after arthroscopic knee surgery.The trials containing other formulated anesthetic drugs,or inclusion of patients suffering from mental illness,preoperative use of sedative and analgesic drugs were excluded.The finally included studies were identified,methodological qualities were assessed and data were extracted.The homogeneous studies were pooled using RevMan 5.2 software.Results Six randomized controlled trials(RCTs)involving 319 patients(159 cases of IA,160 cases of IE)met the inclusion criteria.There was no significant difference in visual analogue scale(VAS)of pain perception between IA and IE group at 8 h and 24 h postoperatively[weighted mean difference(WMD)=-0.01,95%CI(-0.16,0.14),P=0.89;24h:WMD=-0.25,95%CI(-0.54,0.03),P=0.08].The IA morphine significantly resulted in lower incidence of adverse events than IE analgesia[nausea and vomiting:odds ratio(OR)=0.11,95%CI(0.02,0.48),P=0.003;pruritus,OR=0.11,95%CI(0.03,0.37),P=0.0003;urinary retention,OR=0.07,95%CI(0.02,0.25),P<0.0001].Subgroup analysis suggested the influences of dose of morphine on the above results were not statically significant.Conclusion IA morphine could achieve comparable VAS after arthroscopic knee surgery but IA morphine dramatically reduce risk of side effects compared to IE.

关 键 词：镇痛 吗啡 膝关节 META分析 

分 类 号：R61[医药卫生—外科学]