CAJ | 학술논문

背景:关节内注射可乐定或吗啡均能产生镇痛作用,但二者的有效性和安全性存在争议.目的:系统评价关节内注射可乐定对比吗啡治疗膝关节镜术后疼痛的有效性和安全性.方法:计算机检索 PubMed、EMBASE、Cochrane Library、ISI Web of knowledge、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)及万方数据库中关节内注射可乐定对比吗啡治疗膝关节镜术后疼痛的随机对照试验(RCT),检索时间均从建库至2012年1月.两位研究者按照纳入标准筛选文献、提取资料,按照改良 Jadad 评分表评价纳入研究质量,采用RevMan5.1进行 Meta 分析.结果与结论:纳入4个 RCT,合计156例患者.Meta 分析结果:①疼痛目测类比评分:二者在术后1,2,4,6,12,24 h 无差异.②有效镇痛时间:可乐定与吗啡相比能延长术后有效镇痛时间[MD=200.34,95%CI(177.67,223.00),P <0.01].③术后镇痛药的需求率:二者差异无显著性意义[RR=1.05,95%CI(0.67,1.65),P=0.83].④不良反应:二者在术后恶心、呕吐、过度镇静、皮肤瘙痒、低血压和心动过速等不良反应的发生方面的作用无差别.现有证据表明,关节内注射可乐定与吗啡对膝关节镜术后疼痛的缓解程度相同,术后镇痛药的需求率也无明显差异,但可乐定能产生更长的镇痛作用,二者不良反应发生率无差异,结果尚需开展更多研究来证实.
배경:관절내주사가악정혹마배균능산생진통작용,단이자적유효성화안전성존재쟁의.목적:계통평개관절내주사가악정대비마배치료슬관절경술후동통적유효성화안전성.방법:계산궤검색 PubMed、EMBASE、Cochrane Library、ISI Web of knowledge、중국생물의학문헌수거고(CBM)、중문과기기간전문수거고(VIP)、중국기간전문수거고(CNKI)급만방수거고중관절내주사가악정대비마배치료슬관절경술후동통적수궤대조시험(RCT),검색시간균종건고지2012년1월.량위연구자안조납입표준사선문헌、제취자료,안조개량 Jadad 평분표평개납입연구질량,채용RevMan5.1진행 Meta 분석.결과여결론:납입4개 RCT,합계156례환자.Meta 분석결과:①동통목측류비평분:이자재술후1,2,4,6,12,24 h 무차이.②유효진통시간:가악정여마배상비능연장술후유효진통시간[MD=200.34,95%CI(177.67,223.00),P <0.01].③술후진통약적수구솔:이자차이무현저성의의[RR=1.05,95%CI(0.67,1.65),P=0.83].④불량반응:이자재술후악심、구토、과도진정、피부소양、저혈압화심동과속등불량반응적발생방면적작용무차별.현유증거표명,관절내주사가악정여마배대슬관절경술후동통적완해정도상동,술후진통약적수구솔야무명현차이,단가악정능산생경장적진통작용,이자불량반응발생솔무차이,결과상수개전경다연구래증실.
BACKGROUND: Both intraarticular clonidine and morphine can provide analgesic effect, but the efficacy and safety of them are uncertain. OBJECTIVE: To evaluate the efficacy and safety of intraarticular clonidine versus morphine for postoperative analgesia fol owing arthroscopic knee surgery. METHODS: PubMed database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to January 2012 for relevant randomized clinical trials on the intraarticular clonidine versus morphine for postoperative analgesia fol owing arthroscopic knee surgery. Randomized clinical trials met the inclusion criteria were screened and included, and the quality was evaluated using seven-point Jadad scale and the data was analyzed using RevMan 5. 1. RESULTS AND CONCLUSION: Four randomized clinical trials including 156 patients were included. The results of the Meta analysis showed: ①Visual analogue scale scores: there was no difference between intraarticular clonidine and morphine on the visual analogue scale scores at 1, 2, 4, 6, 12 and 24 hours after intraarticular; ②Effective analgesia: intraarticular clonidine could provide longer effective analgesia than morphine [mean difference (MD)=200.34, 95% confidence interval (CI)(177.67, 223.00), P < 0.01]; ③Rate of postoperative analgesic requirements: there was no significant difference of the rate of postoperative analgesic requirements between the two drugs relative risk (RR)=1.05, 95%CI(0.67, 1.65), P=0.83]; ④The incidence of side effects had no significant differences. The current evidence shows that there is no difference between intraarticular rejection of clonidine and morphine on the pain intensity and the rate of postoperative analgesic requirements, but intraarticular clonidine provides longer effective analgesia, and the incidence of side effects is similar. Yet more randomized clinical trials with large sample size are required to explore the question clearly.