肋间神经阻滞对胸腔镜手术后镇痛效果的系统评价与Meta分析  

Effect of intercostal nerve block on postoperative analgesia and outcome of fast track surgery after thoracoscopic surgery:A systematic review and meta-analysis

作　　者：李杰[1] 孙清超[1] 李德生[1] 张海平[1] 于繁 张力为[1] LI Jie;SUN Qingchao;LI Desheng;ZHANG Haiping;YU Fan;ZHANG Liwei(Department of Thoracic Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,830054,P.R.China)

机构地区：[1]新疆医科大学第一附属医院胸外科,乌鲁木齐830054

出　　处：《中国胸心血管外科临床杂志》2022年第4期478-487,共10页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较胸腔镜手术患者行肋间神经阻滞与常规术后药物镇痛的疼痛缓解程度及康复效果。方法计算机检索中国知网、万方数据库、维普、中国生物医学文献数据库、Web of Science、Clinicatrials.gov、Cochrane图书馆、EMbase、PubMed等,收集胸腔镜手术中应用肋间神经阻滞相关的随机对照试验(randomized controlled trial,RCT),搜索时间为建库起至2022年2月10日。对符合纳入标准的文献行数据提取和质量评价后行Meta分析。结果共纳入21项RCT,1项半随机研究,包括1542例患者。22篇文献的主要偏倚风险为执行偏倚。肋间神经阻滞对胸腔镜手术患者术后镇痛效果显著,静息状态术后12 h视觉模拟评分(visual analogue scale,VAS)[MD=–1.45,95%CI(–1.88,–1.02),P<0.00001]、术后24 h VAS评分[MD=–1.28,95%CI(–1.67,–0.89),P<0.00001]、术后48 h VAS评分[MD=–0.90,95%CI(–1.22,–0.58),P<0.00001]均显著降低;运动或咳嗽状态术后24 h VAS评分[MD=–2.40,95%CI(–2.66,–2.14),P<0.00001]、术后48 h VAS评分[MD=–1.89,95%CI(–2.09,–1.69),P<0.00001]均显著降低;且肋间神经阻滞组术后第2 d静脉镇痛自控泵按压次数显著减少[SMD=–0.78,95%CI(–1.29,–0.27),P=0.003]、术后除镇痛泵外需追加阿片类药物用量显著减少[SMD=–2.05,95%CI(–3.65,–0.45),P=0.01]、术后静脉自控镇痛用量减少[SMD=–3.23,95%CI(–6.44,–0.01),P=0.05];患者满意度显著提高[RR=1.31,95%CI(1.17,1.46),P<0.01];胸腔引流管留置时间明显缩短[SMD=–0.64,95%CI(–0.84,–0.45),P<0.001];镇痛相关不良反应发生率显著降低[RR=0.43,95%CI(0.33,0.56),P<0.00001];术后相关并发症发生率明显降低[RR=0.28,95%CI(0.18,0.44),P<0.00001];有2篇研究提示肋间神经阻滞后住院时间显著缩短,差异有统计学意义(P≤0.05),1篇报道无明显差别。结论肋间神经阻滞对胸腔镜术后急性疼痛及运动状态疼痛缓解较突出,经济安全并符合加速康复外科理念,可广泛应�Objective To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery.Methods China National Repository,Wanfang Database,VIP,China Biomedical Literature Database,Web of Science,Clinicaltrials.gov,Cochrane Library,EMbase and PubMed were searched from establishment of each database to 10 Febraray,2022.Relevant randomized controlled trials(RCTs)of intercostal nerve block in thoracoscopic surgery were collected,and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria.Results A total of 21 RCTs and one semi-randomized study were identified,including 1542 patients.Performance bias was the main bias risk.Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery.The visual analogue scale(VAS)score at 12 h after surgery(MD=–1.45,95%CI–1.88 to–1.02,P<0.00001),VAS score at 24 h after surgery(MD=–1.28,95%CI–1.67 to–0.89,P<0.00001),and VAS score at 48 h after surgery significantly decreased(MD=–0.90,95%CI–1.22 to–0.58,P<0.00001).In exercise or cough state,VAS score at 24 h after surgery(MD=–2.40,95%CI–2.66 to–2.14,P<0.00001)and at 48 h after surgery decreased significantly(MD=–1.89,95%CI–2.09 to–1.69,P<0.00001).In the intercostal nerve block group,the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced(SMD=–0.78,95%CI–1.29 to–0.27,P=0.003).In addition to the analgesic pump,the amount of additional opioids significantly reduced(SMD=–2.05,95%CI–3.65 to–0.45,P=0.01).Postoperative patient-controlled intravenous analgesia was reduced(SMD=–3.23,95%CI–6.44 to–0.01,P=0.05).Patient satisfaction was significantly improved(RR=1.31,95%CI 1.17 to 1.46,P<0.01).Chest tube indwelling time was significantly shortened(SMD=–0.64,95%CI–0.84 to–0.45,P<0.001).The incidence of analgesia-related adv

关 键 词：胸腔镜手术 肋间神经阻滞 加速康复外科 疼痛管理 随机对照试验 系统评价/META分析 

分 类 号：R614[医药卫生—麻醉学]