TPVB对全身麻醉下CABG患者术后镇痛效果的影响:meta分析  

Effect of thoracic paravertebral nerve block on postoperative analgesia in patients undergoing CABG under general anesthesia: a meta-analysis

作　　者：徐宁[1] 毕明超 荣伟 Xu Ning;Bi Mingchao;Rong Wei(Department of Anesthesiology,Weihai Central Hospital Affiliated to Qingdao University,Weihai 264400,China)

机构地区：[1]青岛大学附属威海市中心医院麻醉科,威海264400

出　　处：《中华麻醉学杂志》2024年第4期447-453,共7页Chinese Journal of Anesthesiology

摘　　要：目的采用meta分析评价双侧胸椎旁神经阻滞(TPVB)对全身麻醉下冠状动脉搭桥术(CABG)患者术后镇痛效果的影响。方法系统检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方医学网和维普资讯数据库,限定检索时间截止至2023年12月。纳入双侧TPVB联合全身麻醉与单纯全身麻醉比较CABG患者术后镇痛效果的随机对照试验。主要结局指标:术后24 h内补救镇痛率;次要结局指标:术中阿片类药物用量和不良反应发生率、术后恢复指标和术后不良反应发生率。应用R studio软件调用"meta"程序包进行meta分析。结果共纳入9篇文献(n=788)。与全身麻醉相比,双侧TPVB联合全身麻醉可减少术中阿片类药物用量(SMD=-1.88,95%CI-2.80~-0.96),降低术后24 h内补救镇痛率(RR=0.17,95%CI 0.06~0.46)和术后不良反应发生率(RR=0.39,95%CI 0.25~0.60),缩短术后气管拔管时间(MD=-1.52,95%CI-2.01~-1.03)、术后ICU停留时间(MD=-4.40,95%CI-5.29~-3.51)和术后住院时间(MD=-0.70,95%CI-1.37~-0.04)。结论双侧TPVB可增强全身麻醉下CABG患者术后镇痛的效果。Objective To systematically review the effect of bilateral thoracic paravertebral nerve block(TPVB)on postoperative analgesia in the patients undergoing coronary artery bypass grafting(CABG)under general anesthesia(GA)using a meta-analysis.Methods A systematic search of PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang,and VIP databases was performed,with a limited search period ending in December 2023.Randomized controlled trials regarding bilateral TPVB combined with GA versus GA alone for postoperative analgesia following CABG were included.The primary outcome was the rate of 24 h postoperative rescue analgesia.Secondary outcomes were intraoperative opioid consumption,incidence of intraoperative adverse reactions,indicators related to postoperative recovery,and incidence of postoperative adverse reactions.This meta-analysis was performed by using the"meta"package in R studio software.Results A total of 9 papers(n=788)were included.Compared to GA,bilateral TPVB combined with GA reduced intraoperative opioid consumption(SMD=-1.88,95%confidence interval[CI]-2.80--0.96),decreased the rate of 24 h postoperative rescue analgesia(RR=0.17,95%CI 0.06-0.46)and the incidence of postoperative adverse reactions(RR=0.39,95%CI 0.25-0.60)and shortened postoperative extubation time(MD=-1.52,95%CI-2.01--1.03),postoperative intensive care unit stay(MD=-4.40,95%CI-5.29--3.51)and postoperative hospitalization time(MD=-0.70,95%CI-1.37--0.04).Conclusions Bilateral TPVB can enhance the postoperative analgesic effect in the patients undergoing CABG under general anesthesia.

关 键 词：神经传导阻滞 胸椎 麻醉 全身 冠状动脉旁路移植术 镇痛 病人控制 META分析 

分 类 号：R614[医药卫生—麻醉学]