中国药物警戒 ›› 2017, Vol. 14 ›› Issue (10): 626-631.

• 安全性评价与合理用药 • 上一篇    下一篇

右美托咪定联合舒芬太尼术后静脉自控镇痛的有效性和安全性的Meta分析

陈鹏1, 陈富超2, 周本宏1,3*   

  1. 1武汉大学人民医院药学部，湖北武汉430060;
    2湖北医药学院附属东风医院药学部，湖北十堰442008;
    3武汉大学药学院，湖北武汉430071
  • 收稿日期:2017-06-22 修回日期:2017-11-30 出版日期:2017-10-20 发布日期:2017-11-30
  • 通讯作者: 周本宏，男，博士，教授，中药及天然药物活性成分。E-mail：benhongzh＠whu.edu.cn
  • 作者简介:陈鹏，男，在读硕士，中药及天然药物活性成分。
  • 基金资助:
    湖北省卫生计生科研基金项目（WJ2015MB290）：酒食子酸布托啡诺与地佐辛术后多模式镇痛的临床药学研究；十堰市科技计划项目（16Y66）：地佐辛术后多模式镇痛定量检测体系的建立及在镇痛泵中的稳定性。

Meta Analysis of Efficacy and Safety of Dexmedetomidine Combined with Sufentanil for Postoperative Patient-cotrolled Intravenous Analgesia

CHEN Peng1, CHEN Fu-chao2, ZHOU Ben-hong1,3*   

  1. 1.Department of Pharmacy, Renmin Hospital of Wuhan University, Hubei Wuhan 430060, China;
    2.Department of Pharmacy, Dongfeng Hospital Affiliated to Hubei University of Medicine, Hubei Shiyan 442008, China;
    3.School of Pharmaceutical Sciences, Wuhan University, Hubei Wuhan 430071, China
  • Received:2017-06-22 Revised:2017-11-30 Online:2017-10-20 Published:2017-11-30

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摘要： 目的 系统评价右美托咪定联合舒芬太尼与单用舒芬太尼术后患者静脉自控镇痛（patient controlled intravenous analgesia，PCIA）的有效性和安全性。方法 计算机检索 PubMed、Embase、Cochrane 图书馆、CNKI、VIP等数据库，收集右美托咪定联合舒芬太尼术后静脉自控镇痛的随机对照试验（RCT），采用Rev Man 5.3软件对疼痛视觉模拟评分（visual analogue scale，VAS）、镇静评分（Ramsay scale，RSS）、PCIA有效按压次数、不良反应进行Meta分析。结果 联合用药组在术后12、24、48 h的VAS评分均较单用舒芬太尼组低，且均具有统计学意义（P <0.05）；联合用药组在术后12、24、48 h镇静效果较单用舒芬太尼更为显著[WMD=0.68，95%CI（0.35, 1.01）；WMD=0.56，95%CI（0.27, 0.85）；WMD=0.44，95%CI（0.11, 0.76），P <0.05]；联合用药组在12、48 h的PCIA有效按压次数较单用舒芬太尼组低[WMD=-2.64，95% CI（-4.50, -0.78）；WMD=-1.49，95%CI（-6.13, 3.14），P <0.01]；与单用舒芬太尼组相比，联合用药组术后恶心呕吐、皮肤瘙痒、心动过缓及总发生率显著降低（分别为P <0.01、P=0.003、P =0.03和P <0.01）。结论 与单用舒芬太尼组相比，右美托咪定联合舒芬太尼用于PCIA能获得较好的临床镇痛效果，并有效降低不良发应发生率，临床应用更为安全。

关键词: 右美托咪定, 舒芬太尼, 术后静脉自控镇痛, Meta分析, 系统评价

Abstract: Objective To evaluate the efficacy and safety of dexmedetomidine combined with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA). Methods The randomized controlled trials of dexmedetomidine combined with sufentanil for PCIA were gathered from PubMed, Embase, Cochrane library, CNKI and VIP Data. After data extraction and quality assessment of the included RCTs, the RevMan 5.3 software was applied for Meta-analysis of visual analog scale (VAS) score, Ramsay score (RSS), number of bolus applications of PCIA and safety. Results The results of Meta-analyses showed that: ① as for VAS score, compared with the sufentanil group, the combination group had significant differences (P <0.05) at 12, 24 and 48 h post-operation; ②as for Ramsay sedation score, compared with the sufentanil group, the RSS at 12, 24, and 48-hour had significant differences when sufentanil combined with ketamine (WMD=0.68, 95% CI 0.35 to 1.01; WMD=0.56, 95% CI 0.27 to 0.85, WMD=0.44 95% CI 0.11 to 0.76, P<0.05); ③there were significant differences in number of bolus applications of PCIA at 24 and 48 h post-operation between the combined group and the single sufentanil group (WMD=-2.64, 95%CI -4.50 to -0.78; WMD=-1.49, 95%CI -6.13 to 3.14, P<0.01); ④as for adverse reaction in the combination group compared with the single sufentanil group, incidences of nausea and vomiting, itchy skin, bradycardia and total adverse reaction were significantly (P<0.01, P=0.003, P=0.03 and P<0.01) decreased. Conclusion According to the domestic evidence, dexmedetomidine combined with sufentanil for PCIA could effectively alleviate post-operative pain compared with sufentanil alone, and can be able to reduce the incidences of adverse reactions.

Key words: dexmedetomidine, sufentanil, postoperative patient-controlled intravenous analgesia, Meta-analysis, systematic review

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