帕瑞昔布钠预防成人腹腔镜手术麻醉苏醒期躁动的Meta分析

摘要

Objective To provide a systematic review of parecoxib preventing post-laparoscopic-operative emergence agitation in adults plus reliable clinical evidences for an ideal pharmacological management of emergence agitation.Methods A comprehensive literature search was conducted to identify randomized controlled trials that focused on parecoxib preventing emergence agitation post-laparoscopic-operative in adults.The databases included PubMed,EBSCO,Springer,Ovid,EMbase,Cochrane Library,Web of Science and the China Nation Knowledge Infrastructure,Weipu Data Base and Wanfang Data Base.Literature screening had inclusive and exclusive criteria; data extracting,quality assessment and the incidence of emergence agitation,nausea and vomiting were analyzed.Results Nine articles had a total of 580 patients,including 300 cases of parecoxib and 280 cases of saline.The results of meta-analyses showed:compared with normal saline group,parecoxib group had a lower incidence of emergence agitation [relative risk(RR) =0.23,95％ Confidence interval (CI):0.15-0.34],lower RS score (Weighted mean difference =-0.85,95％ CI:-1.12--0.57),lower incidence of postoperative nausea and vomiting(RR =0.34,95％ CI:0.15-0.78),lower analgesic requirement(RR =0.09,95％ CI:0.02-0.44).Conclusion Parecoxib during preemptive analgesia can have a protective effect on emergence agitation.%目的 系统分析帕瑞昔布钠预防成人腹腔镜手术麻醉苏醒期躁动的有效性和安全性,为临床合理用药提供参考.方法 通过检索PubMed、EBSCO、Springer、Ovid、EMbase、Cochrane Library、Web of Science 和中国期刊全文数据库、维普中文科技期刊数据库、万方数据库,查找帕瑞昔布钠预防成人腹腔镜手术麻醉苏醒期躁动的随机对照试验.对符合纳入标准的文献进行质量评价和资料提取,采用RevMan 5.2.7软件对苏醒期躁动的发生率及恶心呕吐等进行Meta分析.结果 最终纳入文献9篇,共计患者580例.其中帕瑞昔布钠组(在麻醉前、麻醉中或麻醉后给予帕瑞昔布钠)300例,对照组(在麻醉前、麻醉中或麻醉后给予0.9％氯化钠注射液)280例.Meta分析结果显示,与对照组相比,帕瑞昔布钠组腹腔镜手术麻醉苏醒期躁动发生率更低[相对危险度(RR)=0.23,95％置信区间:0.15 ～ 0.34],苏醒期躁动评分更低(加权均数差=-0.85,95％置信区间:-1.12～-0.57),术后恶心呕吐发生率更低(RR=0.34,95％置信区间:0.15～0.78),镇痛需求更少(RR=0.09,95％置信区间:0.02 ～0.44).结论 本研究表明帕瑞昔布钠超前镇痛,能有效预防成人腹腔镜手术麻醉苏醒期躁动,且安全性较高.