| 全膝关节置换术前使用COX-2抑制剂对术后镇痛效果的Meta分析 |
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Received:September 17, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 计忠伟 |
JI Zhong-wei |
南京大学医学院临床学院, 南京军区南京总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Nanjing School of Clinical Medicine Nanjing University, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, Jiangsu, China |
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| 包倪荣 |
BAO Ni-rong |
南京大学医学院临床学院, 南京军区南京总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Nanjing School of Clinical Medicine Nanjing University, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, Jiangsu, China |
bnrbnr@sina.com |
| 赵建宁 |
ZHAO Jian-ning |
南京大学医学院临床学院, 南京军区南京总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Nanjing School of Clinical Medicine Nanjing University, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, Jiangsu, China |
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| 倪建法 |
NI Jian-fa |
南京大学医学院临床学院, 南京军区南京总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Nanjing School of Clinical Medicine Nanjing University, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, Jiangsu, China |
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| 期刊信息：《中国骨伤》2015年28卷，第9期，第838-845页 |
| DOI：10.3969/j.issn.1003-0034.2015.09.013 |
| 基金项目:江苏省临床医学科技专项资助项目(编号:BL2012002) |
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目的:采用Meta分析法评价全膝关节置换术前使用COX-2抑制剂对术后镇痛的有效性及安全性.
方法:计算机检索PubMed、Cochrane Library、EMBASE、CNKI、CBM、数字化期刊全文数据库有关全膝关节置换术(TKA)术前应用COX-2抑制剂镇痛的随机对照试验(RCT),检索时间从建库至2014年3月15日,同时手工检索图书馆馆藏期刊.按Cochrane系统评价方法选择文献、提取资料并评价纳入研究质量后,采用RevMan 5.2 软件进行Meta 分析.
结果:经过筛选共纳入6个RCT文献,合计228例患者.Meta分析结果显示:①有效性:与对照组相比,术前使用COX-2抑制剂镇痛在置换术后12 h疼痛视觉模拟评分(VAS)[WMD=-0.60,95%CI(-0.83,-0.37),P<0.00001]、24 h的VAS[WMD=-0.74,95%CI(-1.29,-0.19),P=0.008]、48 h的VAS[WMD=-0.43,95%CI(-0.61,-0.26),P<0.00001]均降低.术后试验组在膝关节静息状态下第1天的改良数字疼痛评分(MNPRS)[WMD=-0.50,95%CI(-0.70,-0.30),P<0.00001]、第2天MNPRS[WMD=-0.55,95%CI(-0.65,-0.45),P<0.00001],以及术后膝关节活动状态下第1天MNPRS[WMD=-0.82,95%CI(-1.26,-0.38),P<0.00001]、第2天MNPRS[WMD=-0.71,95%CI(-0.82,-0.60),P<0.00001]均较对照组降低.同时试验组能降低术后第1天[WMD=-1.35,95%CI(-1.92,-0.79),P<0.00001]、第2天[WMD=-1.60,95%CI(-2.68,-0.52),P=0.004]的吗啡需要量.②安全性:术前使用COX-2抑制剂镇痛术能降低置换术后皮肤瘙痒的发生率[RR=0.35,95%CI(0.15,0.84),P=0.02],但在降低术后恶心呕吐[RR=0.83,95%CI(0.54,1.28),P=0.40]、嗜睡[RR=0.63,95%CI(0.05,7.67),P=0.72]发生率方面与对照组比较差异无统计学意义.
结论:TKA术前采用COX-2抑制剂能有效提高术后镇痛效果且降低吗啡的需要量,同时也可降低术后皮肤瘙痒的发生率. |
| [关键词]:关节成形术,置换,膝 COX-2抑制剂 镇痛 Meta分析 |
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| Effect of preoperative cyclooxygenase-2 inhibitor for postoperative pain in patients after total knee arthroplasty: a meta-analysis |
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Abstract:
Objective: To systematically evaluate the efficacy and safety of preoperative administration of cyclooxygenase-2 (COX-2) inhibitor on pain occurring with total knee arthroplasty(TKA).
Methods: We electronically searched PubMed, Cochrane Library, EMBASE, CNKI, CBM, Wanfang data from inception to March 15, 2014 and manual searched journal of library collection to identify randomized controlled trials(RCTs) about preoperative administration of COX-2 inhibitor on pain occurring with TKA. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook 5.1.0. Meta-analysis was performed by using RevMan 5.2 software.
Results: A total of 6 RCTs involving 228 patients were included. The results of meta-analyses showed that: ①Efficacy: The visual analog scale (VAS) of post-operation at 12-hour (WMD=-0.60, 95%CI -0.83 to -0.37, P<0.000 01) and 24-hour (WMD=-0.74, 95%CI -1.29 to -0.19, P=0.008) was decreased when COX-2 inhibitor was used before operation. And compared with control group, experimental group decreased the modified numerical pain rating scale (MNPRS) at 24-hour (WMD=-0.50, 95%CI -0.70 to -0.30, P<0.000 01), 48-hour (WMD=-0.55, 95%CI -0.65 to -0.45, P<0.000 01) under quiescent conditions, and the same result at 24-hour (WMD=-0.82, 95%CI -1.26 to -0.38, P<0.000 01), 48-hour (WMD=-0.71, 95%CI -0.82 to -0.60, P<0.000 01) under active conditions. The morphine consumption postoperatively were fewer in experimental group at the first day (WMD=-1.35, 95%CI -1.92 to -0.79, P<0.000 01) and the second day (WMD=-1.60, 95%CI -2.68 to -0.52, P=0.004). ②Safety: COX-2 inhibitor could lessen the incidence of postoperative pruritus (RR=0.35, 95%CI 0.15 to 0.84, P=0.02), but not statistically decrease of nausea and vomiting(RR=0.83, 95%CI 0.54 to 1.28, P=0.40) and exhaustion (RR=0.63, 95%CI 0.05 to 7.67, P=0.72).
Conclusion: The current evidence indicated that preoperative administration of COX-2inhibitor can effectively improve the effect of postoperative analgesia, reduce the consumption of morphine and lessen the incidence of pruritus. Due to the limited quantity of the included studies and the evidence with limited strength, further high-quality RCTs are needed to verify the aforementioned conclusion. |
| KEYWORDS:Arthroplasty, replacement, knee Cyclooxygenase-2 inhibitor Analgesia Meta-analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 计忠伟,包倪荣,赵建宁,倪建法.全膝关节置换术前使用COX-2抑制剂对术后镇痛效果的Meta分析[J].中国骨伤,2015,28(9):838~845 |
| 英文格式: | JI Zhong-wei,BAO Ni-rong,ZHAO Jian-ning,NI Jian-fa.Effect of preoperative cyclooxygenase-2 inhibitor for postoperative pain in patients after total knee arthroplasty: a meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(9):838~845 |
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