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帕瑞昔布对比酮咯酸氨丁三醇用于围手术期镇痛有效性和安全性的系统评价
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| 篇名： | 帕瑞昔布对比酮咯酸氨丁三醇用于围手术期镇痛有效性和安全性的系统评价 |
| TITLE： | Efficacy and safety of parecoxib versus ketorolac tromethamine for perioperative analgesia：a systematic review |
| 摘要： | 目的 比较帕瑞昔布与酮咯酸氨丁三醇用于围手术期镇痛的有效性和安全性，为临床用药提供循证参考。方法计算机检索PubMed、Embase、theCochraneLibrary、中国知网、维普网、万方数据库和百度、谷歌网站，收集帕瑞昔布（试验组）对比酮咯酸氨丁三醇（对照组）的随机对照试验（RCT），检索时限为各数据库建库起至2022年6月17日。筛选文献、提取资料后，采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具对纳入文献质量进行评价；采用RevMan5.4软件进行Meta分析、敏感性分析和发表偏倚分析。结果共纳入12项RCT，合计1118例患者。Meta分析结果显示，麻醉诱导前给药时，两组患者的视觉模拟评分（VAS）[MD＝－0.16，95%CI（－0.41，0.09），P＝0.20]、疼痛数字评分（NRS）[MD＝0.01，95%CI（－0.36，0.38），P＝0.97]、术后出血量[MD＝0.15，95%CI（－0.63，0.93），P＝0.71]、术后阿片类镇痛药消耗量[MD＝0.12，95%CI（－0.77，1.01），P＝0.79]比较，差异均无统计学意义。术后给药时，试验组患者的VAS、术后48h出血量均显著低于或少于对照组（P＜0.05）。按不同评估时间进行亚组分析的结果显示，麻醉诱导前给药时，试验组患者术后0h时的VAS显著低于对照组；术后给药时，试验组患者术后12、48h的VAS均显著低于对照组（P＜0.05）。两组患者不良反应发生率比较，差异无统计学意义[RR＝0.93，95%CI（0.78，1.11），P＝0.43]。按不同不良反应类型进行亚组分析的结果显示，试验组患者的恶心呕吐发生率显著低于对照组，其他不良反应发生率显著高于对照组（P＜0.05）。敏感性分析结果显示，本研究所得结果稳健。发表偏倚分析结果显示，本研究存在发表偏倚的可能性较大。结论帕瑞昔布与酮咯酸氨丁三醇术前用于围手术期镇痛的疗效相当；术后给药时，帕瑞昔布的镇痛效果更好、术后出血量更少；无论何时给药，帕瑞昔布的恶心呕吐发生率更低。 |
| ABSTRACT： | OBJECTIVE To compare the efficacy and safety of parecoxib and ketorolac tromethamine for perioperative analgesia， and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI， VIP， Wanfang Data， Baidu and Google， randomized controlled trials （RCT） about parecoxib （trial group） versus ketorolac tromethamine （control group） for perioperative analgesia were collected from the inception to Jun. 17th， 2022. After screening the literature and extracting the data， the quality of the included literature was evaluated using the bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis， sensitivity analysis and publication bias analysis were performed with RevMan 5.4 software. RESULTS A total of 12 RCTs were included， with 1 118 patients. Meta- analysis results showed that at the time of administration before anesthesia induction， there was no statistically significant difference between the 2 groups in visual analogue scale （VAS） [MD＝－0.16， 95%CI （－0.41， 0.09）， P＝0.20]， numerical rating scale （NRS） [MD＝0.01， 95%CI （－0.36， 0.38）， P＝0.97]， postoperative bleeding [MD＝0.15， 95%CI （－0.63， 0.93）， P＝0.71]， and consumption of opioid analgesics [MD＝0.12， 95%CI （－0.77， 1.01）， P＝0.79]. At the time of postoperative administration， VAS and bleeding volume at 48 h after operation of trial group were significantly lower than control group （P＜0.05）. The results of subgroup analysis by different com assessment time points showed that the VAS of patients in trial group at 0 h after operation were significantly lower than control group at the time of administration before anesthesia induction； at the time of postoperative administration， VAS of patients in the trial group at 12 h and 48 h after operation were significantly lower than control group （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups [RR＝0.93，95%CI （0.78，1.11），P＝0.43]. The results of subgroup analysis according to different types of adverse reactions showed that the incidence of nausea and vomiting of trial group was significantly lower than control group， and the incidence of other adverse reactions was significantly higher than control group （P＜0.05）. Results of sensitivity analysis showed that study results were stable and reliable. Results of publication bias analysis showed that there was great possibility of publication bias in this study. CONCLUSIONS The efficacy of parecoxib is equivalent to that of ketorolac tromethamine for perioperative analgesia before operation； at the time of administration after operation， parecoxib has better analgesic effect and less postoperative bleeding； the incidence of nausea and vomiting caused by parecoxib is lower at any time of administration. |
| 期刊： | 2023年第34卷第04期 |
| 作者： | 林茂；胡志强；陈娅；肖洪涛；蒋倩 |
| AUTHORS： | LIN Mao，HU Zhiqiang，CHEN Ya，XIAO Hongtao，JIANG Qian |
| 关键字： | 帕瑞昔布；酮咯酸氨丁三醇；围手术期；镇痛；有效性；安全性 |
| KEYWORDS： | parecoxib； ketorolac tromethamine； perioperative period； analgesia； efficacy； safety |
| 阅读数： | 304 次 |
| 本月下载数： | 10 次 |
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