多模式镇痛在肝癌肝切除患者中有效性及安全性的Meta分析  

Efficacy and safety of multimodal analgesia in hepatectomy patients with liver cancer:a Meta-analysis

作　　者：周梦云 龚财芳 游川[2] ZHOU Mengyun;GONG Caifang;YOU Chuan(Department of Critical Care Medicine,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China;Department of Hepatobiliary I,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China)

机构地区：[1]川北医学院附属医院重症医学科,四川南充637000 [2]川北医学院附属医院肝胆外一科,四川南充637000

出　　处：《数理医药学杂志》2024年第1期59-67,共9页Journal of Mathematical Medicine

基　　金：南充市社社会科学研究“十四五”规划2023年度项目(NC23C119)。

摘　　要：目的系统评价多模式镇痛(multimodal analgesis,MMA)在肝癌肝切除患者中的有效性及安全性。方法计算机检索中国生物医学文献数据库(CBM)、万方(Wanfang Data)、中国知网(CNKI)、维普(VIP)、PubMed、The Cochrane Library、Web of Science、EMbase等文献数据库从建库至2022年6月肝癌患者MMA的随机对照试验(randomized controlled trials,RCTs)。由两名研究人员独立筛选文献、提取数据并评价纳入研究的偏倚风险,采用RevMan 5.4软件进行Meta分析。结果共纳入11项RCTs,包括916例肝癌患者。Meta分析结果显示,试验组患者12 h[SMD=-1.57,95%CI(-1.90,-1.25),P<0.001]、24 h[SMD=-1.57,95%CI(-2.04,-1.11),P<0.001]、48 h[SMD=-1.09,95%CI(-1.48,-0.69),P<0.01]疼痛评分、术后首次排气时间[MD=-6.21,95%CI(-8.15,-4.26),P<0.01]及住院时间[MD=-3.36,95%CI(-3.63,-3.09),P<0.01]、术后不良反应发生率[RR=0.65,95%CI(0.50,0.85),P<0.01]等均低于对照组。结论MMA可有效缓解肝癌肝切除患者的术后疼痛,促进胃肠功能恢复,减少术后不良反应的发生,缩短住院时间,促进术后快速康复。Objective To systematically review the efficacy and safety of multimodal analgesis(MMA)in hepatectomy patients with liver cancer.Methods Randomized controlled trials(RCTs)on the application of multimodal analgesis in patients with hepatocellular carcinoma were searched electronically from CBM,Wanfang Data,CNKI,VIP,PubMed,The Cochrane Library,Web of Science,and EMbase from inception of the databases to June 2022.Two researchers independently reviewed the literature,extracted data and evaluated the risk of bias of the included studies.Meta-analysis was performed by RevMan 5.4 software.Results A total of 11 RCTs were included,involving 916 patients with liver cancer.Meta-analysis results indicated that,compared to the control group,the postoperative pain scores at 12 h[SMD=-1.57,95%CI(-1.90,-1.25),P<0.001],24 h[SMD=-1.57,95%CI(-2.04,-1.11),P<0.001]and 48 h[SMD=-1.09,95%CI(-1.48,-0.69),P<0.01],the first postoperative exhaust time[MD=-6.21,95%CI(-8.15,-4.26),P<0.01],the hospital stay[MD=-3.36,95%CI(-3.63,-3.09),P<0.01],and the incidence of postoperative adverse reactions[RR=0.65,95%CI(0.50,0.85),P<0.01]in the experimental group were lower.Conclusion MMA can effectively alleviate the postoperative pain in hepatectomy patients with liver cancer,promote the recovery of gastrointestinal function,reduce the occurrence of postoperative adverse reactions,shorten the hospitalization time,and promote the rapid recovery.

关 键 词：多模式镇痛 肝癌 肝切除术 META分析 

分 类 号：R735.7[医药卫生—肿瘤]