帕瑞昔布钠与氟比洛芬酯用于外科手术超前镇痛疗效和安全性的Meta分析  

Efficacy and safety of Parecoxib Sodium and Flurbiprofen Axetil on preemptive analgesia in patients undergoing surgery:a Meta-analysis

作　　者：曹璐 雍素云 张鹏[1] 左燕[1] 李茁[1] CAO Lu;YONG Su-yun;ZHANG Peng;ZUO Yan;LI Zhuo(Department of Pharmacy,Shaanxi Provincial People's Hospital,Xi'an 710032,China)

机构地区：[1]陕西省人民医院药学部,西安710032

出　　处：《临床药物治疗杂志》2022年第3期73-80,共8页Clinical Medication Journal

摘　　要：目的系统评价帕瑞昔布钠与氟比洛芬酯用于外科手术超前镇痛的疗效及安全性。方法全面检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、中国生物医学文献数据库、万方和维普数据库,收集关于帕瑞昔布钠和氟比洛芬酯用于外科手术超前镇痛临床疗效和不良反应的随机对照试验,检索时间从建库至2021年5月31日。使用Cochrane系统评价方法筛选文献,评价纳入文献的质量,并提取纳入文献的特征信息,采用RevMan 5.3软件对相应研究指标进行Meta分析。结果最终纳入18篇随机对照研究,1056例患者。Meta分析结果显示,在术后1 h,帕瑞昔布钠组疼痛强度的视觉模拟评分(VAS)显著高于氟比洛芬酯组(MD=0.06,95%CI=0.01~0.11,P=0.02);在术后6 h,两组的VAS评分差异无统计学意义(P>0.05),镇痛效果相当;在术后12、24 h,帕瑞昔布钠组的VAS评分显著低于氟比洛芬酯组(MD=-0.40,95%CI=-0.63~-0.17,P=0.0007;MD=-0.24,95%CI=-0.44~-0.04,P=0.02),镇痛效果更优;在术后24 h内,两组中因疼痛难忍需要追加镇痛药的患者例数基本相当,差异无统计学意义(P>0.05);帕瑞昔布钠和氟比洛芬酯术前应用常见的不良反应为恶心、呕吐、头晕和嗜睡等,且前者不良反应发生率明显低于后者(OR=0.56,95%CI=0.39~0.80,P=0.002)。Egger检验结果表明,纳入研究无明显的发表偏倚(P=0.088;P=0.512)。结论在外科手术中,术前静脉注射帕瑞昔布钠与氟比洛芬酯相比,后者在术后1 h镇痛效果更优,但在术后12、24 h,帕瑞昔布钠的镇痛作用更强更持久。与氟比洛芬酯相比,帕瑞昔布钠的安全性更高。Objective To evaluate the efficacy and safety of Parecoxib Sodium and Flurbiprofen Axetil for preemptive analgesia in patients undergoing surgery.Methods Databases of PubMed,Cochrane Library,Embase,Web of Science,CNKI,CBM,Wanfang and VIP databases were searched to collect randomized controlled trials on the clinical efficacy and adverse reactions of Parecoxib Sodium and Flurbiprofen Axetil for preemptive analgesia in patients undergoing surgery.The retrieval time was from inception through May 31,2021.Adjusted Jadad scale was used to evaluate the quality of the included researches,then the characteristic information was extracted.Meta-analysis was carried out by RevMan 5.3 software.Results Eighteen randomized controlled trials involving 1056 patients were included.The results of Meta-analysis showed that the visual analogue scale(VAS)in Parecoxib Sodium group was significantly higher than that in Flurbiprofen Axetil group 1 hour after surgery(MD=0.06,95%CI=0.01 to 0.11,P=0.02);there was no significant difference in VAS between the two groups at 6 hours after surgery(P>0.05);The VAS score of Parecoxib Sodium group was significantly lower than that of Flurbiprofen Axetil group at 12,24 hours after surgery(MD=-0.40,95%CI=-0.63 to-0.17,P=0.0007;MD=-0.24,95%CI=-0.44 to-0.04,P=0.02),both there were less patients needing additional analgesics due to intolerable pain within 24 hours after surgery,in both the two groups,and the difference has no statistical significance(P>0.05).The common adverse reactions of Parecoxib Sodium and Flurbiprofen Axetil before surgery were nausea,vomiting,dizziness,drowsiness and so on,and the incidence of adverse reactions in the former was significantly lower than that of the latter(OR=0.56,95%CI:0.39 to 0.80,P=0.002).The results of Egger tests showed that there was no significant publication bias(P=0.088;P=0.512).Conclusion Compared with Parecoxib Sodium,Flurbiprofen Axetil has better analgesic effect 1 hour after surgery,but after 12,24 hours,Parecoxib Sodium has stronger and more lasting

关 键 词：帕瑞昔布钠 氟比洛芬酯 外科手术 超前镇痛 META分析 

分 类 号：R971.2[医药卫生—药品] R614[医药卫生—药学]