氟比洛酚酯复合丙泊酚麻醉用于无痛人流术超前镇痛临床效果的Meta分析

摘要

目的 系统评价氟比洛酚酯复合丙泊酚麻醉用于无痛人流术超前镇痛的安全性和有效性.方法 计算机检索PubMed、中国知网、万方和维普数据库,时间限制为自建库到2017年3月,检索关键词:“氟比洛酚酯”“凯纷”“超前镇痛”“人流术”“人工流产”“人流手术”.提取有效数据后用Stata 12.0软件进行Meta分析,比值比(OR)、加权均数差(WMD)及95％可信区间(95％CI)描述相应合并值.根据异质性选择固定效应或随机效应模型.结果 最终纳入14篇相关文献,共涉及1261例患者.Meta分析结果显示氟比洛酚酯超前镇痛可以缩短麻醉诱导时间(WMD=-1.87,P=0.02),稳定术中、术后的平均动脉压(P=0.04、P=0.00)和心率(P=0.00、P=0.03).另外,有效减少丙泊酚注射痛(OR=0.56,P=0.04)及术中患者体动的发生(OR =0.23,P=0.00),降低患者术中呼吸抑制发生(OR=0.10,P=0.00),总体上减少丙泊酚的用量(WMD=-31.16,P=0.00).氟比洛酚酯超前镇痛患者术后苏醒恢复时间短(WMD=-1.54,P=0.00),术后恶心(OR=0.56,P=0.04)以及宫缩痛发生率(OR=0.15,P=0.00),术后疼痛VAS评分较对照组低(WMD=-2.18,P=0.00).结论 氟比洛酚酯复合丙泊酚麻醉用于无痛人流术超前镇痛是安全和有效的,但仍需要更多高质量随机对照试验的进一步研究证实.%Objective To systematically evaluate the clinical effectiveness and safety of Flurbiprofen axetil preemptive analgesia combined Propofol anesthesia on painless abortion.Methods The databases of PubMed,CNKI,Wanfang and VIP were retrieved from the inception to Mar 2017.The literature search was conducted using the following terms:" flurbiprofen "OR" flurbiprofen axetil" AND "preemptive analgesia" AND "induced abortion" OR "abortion technique" OR "abortion".Meta analysis was conducted by Stata 12.0 software after the data was extracted.The pooled results expressed as odds ratio and weighted mean difference,with 95％ confidence interval,respectively.The fixed-effect or random-effect model was performed according to the heterogeneity.Results 14 literatures and involved in 1261 patients were analyzed.Meta analysis showed that the patients with Flurbiprofen axetil preemptive analgesia was significantly associated with shorter induction time (WMD=-1.87,P=0.02),lower intraoperative MAP (P=0.04),postoperative MAP (P=0.00),intraoperative HR (P=0.00) and postoperative HR (P=0.03).And treatment with Flurbiprofen axetil preemptive analgesia also decreased the Propofol induced pain (OR=0.56,P=0.04),intraoperative patient writhe (OR=0.23,P=0.00),respiratory depression (OR=0.10,P=0.00) and Propofol dos (WMD=-31.16,P=0.00).The shorter awakening time (WMD=-1.54,P=0.00) and the lesser incidence of postoperation nausea (OR=0.56,P=0.04),uterus contraction pain (OR=0.15,P=0.00) and postoperation visual analogue scale (WMD=-2.18,P=0.00) was found in patients with Flurbiprofen axetil preemptive analgesia than the patients in control group.Conclusion This meta analysis suggests that Flurbiprofen axetil preemptive analgesia combined Propofol anesthesia on painless abortion is a safe and effective approach based on current evidence.But further randomized controlled trials should be undertaken to confirm these findings.