摘要
目的系统评价小剂量布比卡因复合芬太尼与常规剂量布比卡因两种方式用于椎管内麻醉的安全性和有效性。方法计算机检索PubMed、Embase,Medline、WOS、CNKI、CBM和万方数据库、维普数据库（1990.01~2015.07）,收集小剂量布比卡因复合芬太尼（研究组）与常规剂量布比卡因（对照组）两种方式用于椎管内麻醉安全性和有效性的文献。按照纳入和排除标准,由两位研究人员独立选择文献、提取资料,然后采用RevMan 5.0软件进行Meta分析。结果纳入13个随机对照研究共573例患者。Meta分析结果显示：两组麻醉失败率差异无统计学意义[OR=0.54,95%CI（0.20,1.48）];两组术后镇痛时间差异无统计学意义[WMD=6.08,95%CI（-3.64,15.80）];研究组的低血压发生率明显低于对照组[OR=0.20,95%CI（0.12,0.34）,P〈0.01];两组心动过缓发生率差异无统计学意义[OR=0.41,95%CI（0.06,2.90）];两组恶心呕吐发生率差异无统计学意义[OR=0.28,95%CI（0.08,1.05）];研究组的皮肤瘙痒发生率明显高于对照组[OR=13.29,95%CI（5.44,32.49）,P〈0.01];研究组的尿潴留发生率明显低于对照组[OR=0.11,95%CI（0.04,0.30）,P〈0.01];研究组腰骶部疼痛发生率明显低于对照组[OR=0.14,95%CI（0.04,0.46）,P〈0.01]。结论小剂量布比卡因复合芬太尼可降低低血压、尿潴留及腰骶部疼痛的发生率,但会增加皮肤瘙痒的发生率。
Objective To systematically evaluate the effectiveness and safety of combination of low-dose bupivacaine with fentanyl for spinal anesthesia.Methods We systematically searched （from January 1990 to July 2015）for randomized comparisons of combinations of low-dose bupivacaine with fentanyl （experimental group） with standard dose bupivacaine alone （control group） in adults undergoing surgery with single-injection intrathecal anaesthesia without general anaesthesia in PubMed, Embase Medline, WOS, CNKI, CBM and WanFang, WeiPu Data. Two reviewers independently identified literatures according to inclusion and exclusion criteria. Meta-analysis were performed using RevMan5.0 software. Results Thirteen randomized controlled trials（RCTs）involving 573 patients were included. Results of meta-analysis showed that：There were no differences between experimental and control groups in failure block [ OR = 0.54, 95 % CI （0.20, 1.48） ], postoperative analgesia [WMD=6.08,95% CI（-3. 64, 15.80）], bradycardia [OR=0. 41, 95% CI （0. 06, 2.90）] and nausea l-OR=0. 28, 95% CI （0. 08, 1.05）]. There was evidence of reduction in the risk of hypotension [OR=0.20, 95% CI （0.12, 0.34）, P〈0.01], urinary retention [OR=0.11, 95% CI（0.04, 0.30）, P〈0. 01] and backache in experimental group [OR= 0.14, 95% CI （0. 04, 0. 46）, P〈 0. 01]. The risk of pruritus was increased in experimental group [OR= 13.29, 95% CI （5.44, 32.49）, P〈0. 01]. Conclusion Combinating fentanyl with low-dose bupivacaine can decrease the risk of hypotension, urinary retention and backache, but increase the risk of pruritus for single-shot spinal anesthesia.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2016年第1期78-83,共6页
Journal of Clinical Anesthesiology
