上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2021 , Vol. 41 >Issue 10: 1344 - 1350

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.10.012

论著 · 循证医学

2种镇痛方式在结直肠癌术后应用效果的meta分析

  • 陈智灵 ,
  • 罗晨 ,
  • 赵康佳 ,
  • 沈玲 ,
  • 胡三莲
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  • 1.上海交通大学附属第六人民医院护理部，上海 200233
    2.上海交通大学护理学院，上海 200025
    3.上海交通大学医学院附属新华医院普外科，上海 200092
陈智灵（1996—），女，护士，硕士生；电子信箱：lynnechan@sjtu.edu.cn
陈智灵（1996—），女，护士，硕士生；电子信箱：lynnechan@sjtu.edu.cn
胡三莲，电子信箱：liuliu9027@163.com。#为共同通信作者。
沈 玲，电子信箱：shenling@xinhuamed.com.cn

网络出版日期: 2021-09-23

基金资助

上海市教育委员会护理高原学科建设项目—多学科创新基金项目(Hlgy1808dxk)

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Application of two kinds of analgesia after colorectal cancer surgery: a meta-analysis

  • Zhi-ling CHEN ,
  • Chen LUO ,
  • Kang-jia ZHAO ,
  • Ling SHEN ,
  • San-lian HU
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  • 1.Department of Nursing, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
    2.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
    3.Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
HU San-lian, E-mail: liuliu9027@163.com. #Co-corresponding authors.
SHEN Ling, E-mail: shenling@xinhuamed.com.cn

Online published: 2021-09-23

Supported by

Shanghai Municipal Education Commission of Nursing Gaoyuan Discipline Construction Project—Multidisciplinary Innovation Fund Project(Hlgy1808dxk)

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摘要

目的·探讨硬膜外镇痛和静脉镇痛2种镇痛方式对结直肠癌术后患者的镇痛效果和安全性。方法·系统检索中国期刊全文数据库（CNKI）、万方期刊数据库、中国生物医学文献数据库（CBM）、维普期刊数据库4个中文数据库及PubMed、Web of Science、Embase、Cochrane Library、Joanna Briggs Institute（JBI）5个国外数据库中有关静脉镇痛和硬膜外镇痛2种镇痛方式对结直肠癌术后患者的应用效果的随机对照试验（randomized controlled trial，RCT）、半随机对照试验（controlled clinical trial，CCT）和病例对照研究（case-control study，CCS）。文献发表时间限定为2010年1月至2020年11月，语言为中文及英文。3名研究人员严格依据标准独立进行文献筛选和质量评价，并提取研究类型、样本量、年龄、术中麻醉方式、术后镇痛药物、结局指标等有效数据录入RevMan 5.4软件进行meta分析。结果·共纳入20篇文献，其中13篇RCT、6篇CCT、1篇CCS，共计1 615例患者，其中硬膜外镇痛813例，静脉镇痛802例。Meta分析结果显示，与静脉镇痛患者相比，硬膜外镇痛患者术后6 h、24 h、48 h疼痛视觉模拟评分（visual analogue score，VAS）显著降低，术后住院时间和首次进食时间显著缩短、肠梗阻发生率及恶心呕吐发生率显著降低，差异均有统计学意义（均P<0.05）。结论·对于结直肠癌术后患者，硬膜外镇痛较静脉镇痛在术后6 h、24 h、48 h的镇痛效果更佳，可有效缩短其术后首次进食时间及住院时间，降低肠梗阻和恶心呕吐的发生率。

关键词： 结直肠癌; 硬膜外镇痛; 静脉镇痛; 镇痛效果; meta分析

本文引用格式

陈智灵 , 罗晨 , 赵康佳 , 沈玲 , 胡三莲 . 2种镇痛方式在结直肠癌术后应用效果的meta分析[J]. 上海交通大学学报（医学版）, 2021 , 41(10) : 1344 -1350 . DOI: 10.3969/j.issn.1674-8115.2021.10.012

Abstract

Objective

·To explore the safety and the analgesia effect of intravenous analgesia and epidural analgesia in the patients with colorectal cancer after surgery.

Methods

·The literature search was conducted in the Chinese databases, i.e. CNKI, WanFang, CBM, and VIP, and the abroad databases, i.e. PubMed, Web of Science, Embase, Cochrane Library and Joanna Briggs Institute (JBI) for randomized controlled trials (RCTs), controlled clinical trials (CCTs) and case-control studies (CCSs) about the effects of intravenous analgesia and epidural analgesia on the patients with colorectal cancer after surgery from January 2010 to November 2020, in the languages of Chinese and English. Three researchers independently conducted literature screening and quality evaluation in strict accordance with the standards, and extracted effective data such as study type, sample size, age, intraoperative anesthesia mode, postoperative analgesic drugs and outcome indicators, which were input into RevMan 5.4 software for meta-analysis.

Results

·A total of 20 literatures, including 13 RCTs, 6 CCTs and 1 CCS, involving 1 615 patients. There were 813 cases in the epidural analgesia group and 802 cases in the intravenous analgesia group. Compared with intravenous analgesia, postoperative epidural analgesia had significant lower visual analogue scores (VAS) of pain at 6 h, 24 h, and 48 h, shorter hospital stay and time to first feeding after operation, and lower incidences of ileus and nausea and vomiting (all P<0.05).

Conclusion

·Compared with intravenous analgesia, postoperative epidural analgesia for the colorectal neoplasms patients is better in the analgesic effect 6 h, 24 h, and 48 h after surgery, effectively shortens the hospital stay and time to first feeding after operation, and reduces the incidences of ileus and nausea and vomiting.

Key words： colorectal cancer; epidural analgesia; intravenous analgesia; analgesic effect; meta-analysis

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