闭孔神经阻滞对闭孔神经反射及并发症发生率影响的Meta分析

摘要

Objective To evaluate systemically the effect of obturator nerve block(ONB)on obturator nerve reflex and complications in the clinical treatment of bladder tumor. Methods Two researchers independently searched PubMed database,EMBASE and the Cochrane Central Register,CBM,Wanfang database,CNKI Chinese Journal Full-text Database to extract the data according to inclusion and exclusion criteria strictly. The incidences of obturator reflex and complications with or without obturator nerve block were evaluated by calculating pooled relatives risk(RRs)and associated 95% CIs. Results Nineteen trials with 1 397 patients were included in this Meta-analysis. The incidence of obturator reflex was lower in obturator nerve block group than in control group(RR=0.15,95% CI 0.11-0.21,P<0.000 01). The incidence of bladder perforation was lower in obturator nerve block group than in control group(RR=0.18,95% CI 0.10-0.31,P<0.000 01). The recurrence of bladder wall tumor in one year was lower in obturator nerve block group than in control group(RR=0.56,95%CI 0.40-0.78,P=0.000 8). Conclusion The findings indicate that ONB may re-duce the incidence of obturator reflex in patients with bladder tumor during transuretheal resection of lateral bladder wall tumor.%目的 运用循证医学方法对闭孔神经阻滞对经尿道膀胱肿瘤电切术中闭孔神经反射及并发症的发生率的影响进行系统评价. 方法 两位研究人员独立检索了PubMed数据库、Embase数据库、Cochrane Library、CBM、万方数据库、中国知网期刊全文数据库,严格按照纳入和排除标准选入与闭孔神经反射相关的随机对照试验.在数据整合过程中,提取闭孔神经阻滞组或对照组闭孔神经反射及并发症发生率的相关数据并计算相应的RR值及95%CI. 结果 19篇随机对照试验(包括1397个病人)被纳入该项Meta分析中.与对照组相比,闭孔神经阻滞组闭孔神经反射的发生率明显降低(RR=0.15,95%CI 0.11-0.21,P<0.00001);与对照组相比,闭孔神经阻滞组膀胱穿孔并发症的发生率明显降低(RR=0.18,95%CI 0.10 -0.31,P<0.00001);与对照组相比,闭孔神经阻滞组1年内肿瘤复发率降低(RR=0.56,95%CI 0.40-0.78,P=0.0008).结论 闭孔神经阻滞能有效降低经尿道膀胱肿瘤电切术中闭孔神经反射及并发症的发生率.