术前预防性使用褪黑素缓解术后急性疼痛效果的Meta分析  

Effect of prophylactic melatonin for alleviating postoperative acute pain:a meta-analysis

作　　者：周蓉[1] 张莹莹 谷万杰[1] ZHOU Rong;ZHANG Yingying;GU Wanjie(Department of Anesthesiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《临床麻醉学杂志》2022年第10期1076-1082,共7页Journal of Clinical Anesthesiology

摘　　要：目的评价术前预防性使用褪黑素对缓解术后急性疼痛的效果。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方和维普等数据库,时间从建库至2021年9月20日,术前预防性使用褪黑素用于缓解术后急性疼痛的随机对照试验,根据Cochrane干预措施系统评价手册推荐的方法进行Meta分析。结果共纳入21篇文献,共计1589例患者,其中褪黑素组860例,对照组729例。与对照组比较,褪黑素组术后6 h(MD=-1.65分,95%CI-2.20~-1.11分,P<0.05)、12 h(MD=-1.16分,95%CI-2.09~-0.23分,P<0.05)、24 h(MD=-1.13分,95%CI-1.41~-0.86分,P<0.05)的VAS疼痛评分明显降低,术中芬太尼用量明显减少(MD=-19.59μg,95%CI-33.28~-5.9μg,P<0.05),术后首次给予镇痛药时间明显延长(MD=60.21 min,95%CI 44.08~76.34 min,P<0.05),术后24 h内镇痛药用量明显减少(SMD=-1.46,95%CI-2.05~-0.86,P<0.05),术后补救镇痛率明显降低(RR=0.52,95%CI 0.29~0.95,P=0.03)。两组住院时间和不良反应发生率差异无统计学意义。结论术前预防性使用褪黑素可减轻术后急性疼痛,减少术后镇痛药用量,且不增加术后不良反应。Objective To assess the efficacy of prophylactic melatonin for postoperative acute pain.Methods PubMed,Embase,Cochrane Library,CNKI,WanFang,and VIP were searched from inception to September 20th,2021 to identify randomized controlled trials which assessed the effect of prophylactic melatonin on postoperative acute pain.Meta-analysis was performed in accordance with the recommendation of Cochrane Handbook for Systematic Reviews of Interventions.Results Twenty-one trials involving 1589 patients met the inclusion criteria,860 patients in the melatonin group and 729 patients in the placebo group.Compared with the placebo group,the melatonin group had the lower VAS score at 6 hours(MD=-1.65,95%CI-2.20 to-1.11,P<0.05),12 hours(MD=-1.16,95%CI-2.09 to-0.23,P<0.05)and 24 hours(MD=-1.13,95%CI-1.41 to-0.86,P<0.05)after surgery,and the less consumption of intraoperative fentanyl(MD=-19.59μg,95%CI-33.28 to-5.9μg,P<0.05).In the melatonin group,the time to first analgesic request after surgery was extended(MD=60.21 min,95%CI 44.08 to 76.34 min,P<0.05),and the total consumption of postoperative analgesia within 24 hours(SMD=-1.46,95%CI-2.05 to-0.86,P<0.05),and the incidence of extra use of analgesic after surgery(RR=0.52,95%CI 0.29 to 0.95,P=0.03)were significantly decreased.There were no significant differences in the length of hospital stay and the occurrence of adverse effects between the two groups.Conclusion Prophylactic melatonin as a premedication could decrease acute pain intensity and the use of analgesics without increasing the risk of postoperative adverse effects.

关 键 词：褪黑素 术后急性疼痛 META分析 

分 类 号：R614[医药卫生—麻醉学]