中国循证医学杂志

中国循证医学杂志

股神经阻滞用于全膝关节置换术术后镇痛有效性的系统评价再评价

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目的 对股神经阻滞(femoral nerve block,FNB)用于全膝关节置换术(total knee replacement,TKR)术后镇痛有效性的系统评价进行再评价。 方法 计算机检索 The Cochrane Library、PubMed、EMbase、CNKI、WanFang Data 和 VIP 数据库,纳入股神经阻滞用于全膝关节置换术术后镇痛有效性的系统评价,检索时限均为建库至 2016 年 7 月。由 2 位研究者按纳入与排除标准筛选文献,提取资料。纳入系统评价的方法学质量评价采用 AMSTAR 进行评价。采用术后疼痛评分和阿片类药物使用量作为主要评价指标对其镇痛有效性进行再评价。 结果 共纳入了 16 个系统评价,分别评价了股神经阻滞和局部浸润镇痛(LIA)、关节周围镇痛药物注射(PMDI)、硬膜外镇痛(EA)、静脉阿片类药物患者自控镇痛(PCA)、收肌管阻滞(ACB)相比较的有效性。纳入系统评价的方法学质量结果显示系统评价的质量均一般,评分范围为 3~9 分。纳入的系统评价术后疼痛评分结果显示:静息时,股神经阻滞在术后 6 h 的镇痛效果并不优于局部浸润镇痛的效果,但在术后 12 h,其镇痛效果优于关节周围镇痛药物注射;其效果在术后 24 h 优于静脉阿片类药物患者自控镇痛和局部浸润镇痛,但不优于收肌管阻滞镇痛效果。在运动时,股神经阻滞在术后 24 h 镇痛效果优于静脉阿片类药物患者自控镇痛和局部浸润镇痛效果,其在术后 48 h 镇痛效果优于静脉阿片类药物患者自控镇痛。在阿片类药物使用量方面,股神经阻滞镇痛在术后 12 h 时使用阿片类药物量多于局部浸润镇痛,而其在术后 24 h 时阿片类药物量少于静脉阿片类药物患者自控镇痛和局部浸润镇痛,其在术后 48 h 时使用阿片类药物量也少于静脉阿片类药物患者自控镇痛和收肌管阻滞。股神经阻滞在患者满意度方面优于收肌管阻滞、硬膜外镇痛和静脉阿片类药物患者自控镇痛。 结论 本研究结果显示股神经阻滞用于全膝关节置换术术后镇痛效果优于静脉阿片类药物患者自控镇痛、局部浸润镇痛,其患者满意度较好。受纳入研究的数量和质量的限制,本研究结论尚需要更多研究予以验证。

Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNBvs. LIA, PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews’ results showed that: at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients’ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.

关键词: 股神经阻滞; 全膝关节置换术; 系统评价; 系统评价再评价

Key words: Femoral nerve block; Total knee replacement; Systematic review; Overview of systematic review

引用本文: 程序, 郑琳莉, 徐毅, 吴佳慧, 张文胜. 股神经阻滞用于全膝关节置换术术后镇痛有效性的系统评价再评价. 中国循证医学杂志, 2017, 17(3): 283-290. doi: 10.7507/1672-2531.201701071 复制

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