摘要
目的:系统评价阿片药物联合加巴喷丁治疗中重度癌性疼痛的临床疗效和安全性.方法:检索PubMed、Medline、CNKI、VIP、CMB、万方等数据库中关于阿片药物联合加巴喷丁对比单用阿片药物治疗中重度癌性疼痛的随机对照研究,检索年限为2000年1月至2017年10月.由2名研究者独立提取数据、评价质量,并交叉核对.采用RevMan 5.2软件进行Meta分析.结果:共纳入14项研究,920例病人.Meta分析结果显示,相对于单用阿片药物,阿片药物联合加巴喷丁能显著降低疼痛评分[MD=-0.71,95%CI(-0.82--0.60),P<0.01]、显著减少阿片药物日均剂量[MD=-17.04,95%CI(-22.43--11.65),P<0.01]和显著提高生活质量[MD=-0.86,95%CI(-1.14--0.59),P<0.01].在不良反应发生率方面,与单用阿片药物相比,阿片药物联用加巴喷丁能显著减少便秘,恶心、呕吐的发生率,差异均有统计学意义(P<0.01),但不能减少头痛、头晕,嗜睡和尿潴留的发生率,差异均无统计学意义(P>0.05).按照阿片药物类别进行亚组分析结果与上述Meta分析结果一致.倒漏斗图提示文献发表偏倚较小.结论:阿片药物联合加巴喷丁用于中重度癌痛病人疗效确切,同时可显著降低便秘和恶心呕吐等发生率.
Objective:To systematically evaluate the clinical efficacy and safety of opioid drugs combined with gabapentin for the treatment of moderate to severe cancer pain. Methods:Databases including PubMed, Medline, CNKI, VIP, CMB and WanFang Data were searched to collect randomized controlled trials (RCTs) about opioid drugs combined with gabapentin versus opioid drugs alone for moderate to severe cancer pain from Jan. 2000 to Oct. 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.2 software. Results:Total of 14 RCTs, 920 patients were included . Meta-analysis showed that , compared with opioid drugs alone , opioid drugs combined with gabapentin could significantly reduce pain score [MD =-0.71, 95%CI (-0.82--0.60), P < 0.01], significantly reduce the daily dose of opioid drugs [MD =-17.04, 95%CI (-22.43--11.65), P < 0.01] and improve quality of life [MD =-0.86, 95%CI (-1.14--0.59), P < 0.01]. In the incidence of adverse reactions, compared with opioid drugs alone, opioid drugs combined with gabapentin could reduce the rate of constipation,nausea and vomiting, and the difference had statistical significance (P < 0.01), but could not reduce the rate of headache, dizziness, lethargy and urinary retention, and the difference had no statistical significance (P > 0.05). Sub-group analysis by opioid category were consistent with Meta-analysis. The funnel plot suggested that the publication bias was small. Conclusion:Opioids combined with gabapentin are effective for patients with moderate to severe cancer pain, and can significantly reduce the incidence of constipation, nausea and vomiting.
作者
左蕾
杨晓秋
周泽军
孙琳
ZUO Lei;YANG Xiao-Qiu;ZHOU Ze-Jun;SUN Lin(Department of Pain Management, First Affiliated Hospital of Chongqing Medical University, Chongqing,400016, China)
出处
《中国疼痛医学杂志》
CAS
CSCD
北大核心
2019年第7期504-512,共9页
Chinese Journal of Pain Medicine
