计算机检索 The Cochrane Central Register of Controlled Trials（CENTRAL）、PubMed、EMbase、CNKI、WanFang Data、VIP 和 SinoMed 等数据库，搜集比较氢吗啡酮与吗啡应用于剖宫产术后镇痛的随机对照试验（RCT），检索时限均为建库至 2017 年 12 月。由 2 名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 RevMan 5.3 软件进行 meta 分析。
共纳入 7 个 RCT，共 586 例剖宫产术后产妇。meta 分析结果显示：氢吗啡酮组术后硬膜外镇痛泵给药 6 h ［MD=–0.23，95%CI（–0.38，–0.08），P=0.003］、12 h ［MD=–0.56，95%CI（–1.10，–0.02），P=0.04］、24 h ［MD=–0.37，95%CI（–0.65，–0.09），P=0.01］和 48 h ［MD=–0.41，95%CI（–0.74，–0.08），P=0.01］的疼痛视觉模拟评分（VAS）均低于与吗啡组。但两组在各时点 Ramsay 镇静评分的差异均无统计学意义。不良反应方面，氢吗啡酮组的瘙痒发生率［RR=0.27，95%CI（0.09，0.81），P=0.02］和呕吐发生率［RR=0.15，95%CI（0.03，0.65），P=0.01］均低于吗啡组，其差异均有统计学意义。
To systematically review the efficacy and safety of hydromorphone and morphine in post-cesarean section analgesia.
The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed databases were electronically searched to identify randomized controlled trials (RCTs) of hydromorphone vs. morphine in the treatment of postoperative analgesia after cesarean section from the inception of the database to December 2017. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included trials. The meta-analysis was conducted with RevMan 5.3 software.
Seven trials with 586 post-cesarean section patients were included. The results of the meta-analysis showed that, compared with the morphine group, the hydromorphone group had lower 6 h (MD=–0.23, 95%CI –0.38 to –0.08, P=0.003), 12 h (MD=–0.56, 95%CI –1.10 to –0.02, P=0.04), 24 h (MD=–0.37, 95%CI –0.65 to –0.09, P=0.01) and 48 h (MD=–0.41, 95%CI –0.74 to –0.08, P=0.01) postoperative VAS scores the with epidural anesthesia pump (PECA). There was no statistically significant difference of the postoperative Ramsay scores between the two groups. In terms of side effects, the incidence of skin pruritus (RR=0.27, 95%CI 0.09 to 0.81. P=0.02) and vomit (RR=0.15, 95%CI 0.03 to 0.65, P=0.01) of the hydromorphone group were lower than those of the morphine group.
The current evidence demonstrate that, compared with morphine, hydromorphone has better postoperative analgesia performance and less risk of exhibiting skin pruritus and vomit after cesarean section. Considering of the overall quality of evidence and the relatively small pooled sample size, more well-conducted randomized controlled trials are required to verify the above conclusion.
Randomized controlled trial
苏夏雯, 黄智然, 刘诗洋, 支梦佳, 耿帅, 刁一凡, 孙静, 刘远立. 氢吗啡酮与吗啡用于剖宫产术后镇痛的有效性和安全性的系统评价. 中国循证医学杂志, 2019, 19(2): 165-172. doi: 10.7507/1672-2531.201808004