围手术期干预对乳腺切除术后慢性疼痛综合征预防作用的系统评价

摘要

目的：系统评价围手术期干预对于乳腺切除术后慢性疼痛综合征的预防效果。方法：在中国生物医学文献数据库（Chinese Biomedical Literature Database，CBM）、中国知识基础设施（China National Knowledge In-frastructure，CNKI）数据库、维普中文科技期刊数据库（1993年-2012年）及 Medline（1946年-2014年）、Em-base（1974年-2014年）和 the Cochrane Library 等数据库中查阅研究终点为围手术期干预对乳腺切除术后慢性疼痛综合征预防作用的随机对照临床试验文献，并进行系统性的分析评价。结果：共14个研究纳入本系统评价，结果表明围手术期应用加巴喷丁类药物可显著降低术后慢性疼痛的发生机率（P =0.002，OR =0.43，95%CI：0.25～0.74）；局部麻醉药物区域浸润或静脉注射可降低术后慢性疼痛的发生率；局麻药物混合膏剂（ EM-LA）外用可降低术后慢性疼痛的发生率；术前椎旁阻滞可显著降低术后慢性疼痛的发生率（ P =0.0009，OR=0.21，95% CI：0.08～0.53）；NSAIDs 类药物的围手术期应用可减轻术后急性期疼痛的程度，但对慢性疼痛的发生率无明显影响。结论：围术期应用加巴喷丁类药物、抗焦虑类药物和局部麻醉药以及术前椎旁阻滞阵痛都可能降低乳腺切除术后慢性疼痛的发生机率。NSAIDs 类药物的围手术期应用可减轻术后急性期疼痛的程度，但对慢性疼痛的发生率无明显影响。今后应在现有试验结果的基础上，开展更多大样本的高质量随机对照研究进行验证。%Objective:To analyze the current intervention of perioperative pain of cancer patients. Methods:A sys-temic wide literature research and review was conducted in following databases:CBM,CNKI,VIP,Medline,Embase and the Cochrane Library,all researches are up to date. Results:Total of 14 randomized controlled trails met the in-clusion criteria. Perioperative gabapentinoids reduced the prevalence of chronic pain after mastectomy(P = 0. 002,OR= 0. 43,95% CI:0. 25 ~ 0. 74). Intravenous and topical lidocaine and perioperative EMLA(eutectic mixture of local anesthetic)cream reduced the incidence of chronic pain after mastectomy. Perioperative NSAIDs didn't affect inci-dence of chronic post mastectomy pain. Preoperative paravertebral blockade exerts preventive effect of chronic pain(P= 0. 000 9,OR = 0. 21,95% CI:0. 08 ~ 0. 53). Conclusion:Perioperative gabapentinoids,antidepressants,local anes-thetics and regional anesthesia may potentially reduce the incidence of post mastectomy pain syndrome. NSAIDs was not effective at reducing chronic pain. More evidence is needed in validating these conclusions and therefore more ap-propriate and comprehensive trials should be implemented.