艾司氯胺酮联合罗哌卡因用于臂丛阻滞有效性的贝叶斯网状Meta分析  

Efficacy of esketamine combined with ropivacaine for brachial plexus block:a Bayesian network Meta-analysis

作　　者：宋文琴 张珂[1] 徐宁[1] Song Wenqin;Zhang Ke;Xu Ning(Department of Anesthesiology,Weihai Central Hospital affiliated to Qingdao University,Weihai City,Shandong Province 264400,China)

机构地区：[1]青岛大学附属威海市中心医院麻醉科,威海市264400

出　　处：《中华疼痛学杂志》2024年第6期898-904,共7页Chinese Journal Of Painology

摘　　要：目的采用贝叶斯网状Meta分析系统评价艾司氯胺酮联合罗哌卡因用于臂丛阻滞的疗效。方法遵循系统评价、Meta分析的PRISMA声明的检索策略,以艾司氯胺酮、罗哌卡因、臂丛阻滞为检索词,系统检索Pubmed、Cochrane Library、Embase、Web of Science、中国知网、维普数据库以及万方数据库,检索时限从建库起至2024年5月30日。纳入有关艾司氯胺酮联合罗哌卡因臂丛阻滞的随机对照试验(RCTs)或观察性研究。根据臂丛阻滞药物的不同将患者分为艾司氯胺酮作为局麻药佐剂联合罗哌卡因组(A组),艾司氯胺酮预先静脉注射联合罗哌卡因组(B组)和罗哌卡因组(C组)。利用R studio软件对臂丛阻滞感觉阻滞起效时间、感觉阻滞持续时间、运动阻滞起效时间以及运动阻滞持续时间进行贝叶斯网状Meta分析,并依据累计概率排名曲线下面积(SUCRA)和排序概率预测疗效。结果共纳入7篇RCTs和1篇回顾性队列研究,包含761例患者,其中A组211例,B组174例,C组366例。贝叶斯网状Meta分析结果显示:A组、B组感觉阻滞持续时间[MD=124.79,95%CI(81.01,174.21);MD=78.46,95%CI(25.95,131.91)]和运动阻滞持续时间[MD=103.92,95%CI(89.01,118.83);MD=93.26,95%CI(65.30,120.68)]均长于C组;但3组感觉阻滞和运动阻滞起效时间差异均无统计学意义(P均>0.05);且A组、B组各指标差异均无统计学意义(P均>0.05)。SUCRA排序显示:在感觉阻滞起效时间、感觉阻滞持续时间、运动阻滞起效时间和运动阻滞持续时间方面,艾司氯胺酮作为局麻药佐剂优于预先静脉注射的概率均较大;排序概率显示:在各方面,排名第一的均为艾司氯胺酮作为局麻药佐剂。结论艾司氯胺酮联合罗哌卡因可以延长臂丛阻滞效果,且推荐艾司氯胺酮作为局麻药佐剂联合罗哌卡因。ObjectiveTo systematically evaluate the efficacy of esketamine combined with ropivacaine for brachial plexus block by Bayesian network Meta-analysis.MethodsFollowing the retrieval strategy of PRISMA statement of systematic review and Meta-analysis,randomised controlled trials(RCTs)or observational studies on esketamine combined with ropivacaine for brachial plexus block were retrieved from Pubmed,Cochrane Library,Embase,Web of Science,CNKI,VIP and Wanfang databases from the establishment of each database to 30 May,2024,with the search terms"esketamine""ropivacaine"and"brachial plexus block".Patients were divided into three groups based on the different medication brachial plexus block medications:group A(esketamine as a local anesthetic adjuvant combined with ropivacaine),group B(esketamine pre-administered intravenously combined with ropivacaine),and group C(ropivacaine alone).The outcome measures included the onset time and duration of sensory block,the onset time and duration of motor block.Bayesian network Meta-analysis on the onset time and duration of sensory block,the onset time and duration of motor block,was performed using by the R Studio software,with efficacy predicted according to the surface under the cumulative ranking curve(SUCRA)and ranking probability.ResultsA total of 7 RCTs and 1 retrospective cohort study were included,involving 761 patients,with 211 in group A,174 in group B,and 366 in group C respectively.Bayesian network Meta-analysis results showed that the duration of sensory block[MD=124.79,95%CI(81.01,174.21);MD=78.46,95%CI(25.95,131.91)]and motor block[MD=103.92,95%CI(89.01,118.83);MD=93.26,95%CI(65.30,120.68)]in group A and group B were all longer than those in group C.The onset time of sensory block and motor block had no statistically significant differences among 3 groups(all P>0.05);and no statistically significant differences in all indices between group A and group B(all P>0.05).SUCRA ranking indicated that the probability of esketamine as an adjuvant to local anesthetic being

关 键 词：氯胺酮 罗哌卡因 臂丛神经阻滞 贝叶斯网状Meta分析 

分 类 号：R61[医药卫生—外科学]