目的：系统评价羟考酮联合阿片类受体拮抗剂与单独应用羟考酮处理疼痛的疗效。方法全面检索Pubmed、Embase、Cochrane图书馆及中国学术期刊全文数据库（ CNKI）等数据库，收集羟考酮联合阿片类受体拮抗剂处理疼痛的随机对照试验（ RCT）。制定纳入与排除标准，根据Cochrane系统评价方法对纳入的研究进行方法学质量评价，并用Review Manager 5�1软件进行Meta分析。结果共纳入包括2003例患者在内的6项RCT。 Meta分析结果显示，与单独用药组相比，联合组显著降低肠功能指数评分（ MD＝－13�86，95％CI：－16�85～－10�86，P＜0�00001），减少便秘发生率（ RR＝0�70，95％CI：0�61～0�80，P＜0�00001），差异均有统计学意义。两组在疼痛程度评分（ MD＝0�06，95％CI：－0�17～0�29，P＝0�60）、腹泻发生率（ RR＝1�22，95％CI：0�79～1�89，P＝0�37）、神经系统不良反应发生率（ RR＝1�08，95％CI：0�88～1�32，P＝0�48）以及全身性和给药部位不良反应发生率（ RR＝1�11，95％CI：0�81～1�53，P＝0�51），差异均无统计学意义。结论与单独应用羟考酮治疗疼痛相比，联合应用阿片类受体拮抗剂可以在不影响镇痛效果的情况下促进肠功能改善和降低便秘发生率，且不会增加不良反应的发生率，因而是一种较为理想的止痛方法。%Objective To evaluate the effectiveness of oxycodone combined with opioid receptor antagonists in the manage⁃ment of pain. Methods We searched Pubmed, Embase, Cochrane Library, and CNKI database to acquire the randomized controlled trials ( RCTs) about oxycodone combined with opioid receptor antagonists in the treatment of pain. After evaluating methodological qual⁃ity and extracting data, Meta⁃analysis was performed using RevMan5�1 software. Results A total of 6 RCTs involving 2003 patients were included. Meta⁃analysis showed that the combination group was superior to the oxycodone group with significant differences in the bowel function index scores(MD=-13�86, 95%CI:-16�85⁃-10�86, P<0�000 01) and the incidence of constipation(RR=0�70, 95%CI:0�61⁃0�80,P<0�000 01) . There were no significant difference in the pain intensity scores( MD=0�06, 95%CI:-0�17⁃0�29, P=0�60), the incidence of diarrhea(RR=1�22, 95%CI:0�79⁃1�89, P=0�37), the incidence of adverse reactions of the nervous system(RR=1�08, 95%CI:0�88⁃1�32,P=0�48) and general disorders or administration site(RR=1�11, 95%CI:0�81⁃1�53, P=0�51) . Conclusion Compared to oxycodone alone group, the combination group promot the bowel function and reduce the incidence of constipation without affecting analgesia situation and can not increase the incidence of adverse reactions, and thus it can be an ideal analgesic method.
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