CAJ | 학술논문

目的：评价布托啡诺联合芬太尼术后静脉自控镇痛（PCIA）的临床效果与安全性。方法计算机检索 PubMed、ISI、CBM、CNKI 和 VIP，收集布托啡诺联合芬太尼术后静脉自控镇痛的随机对照试验（RCT），采用 RevMan 5．2软件对 VAS 评分、RSS 评分、不良反应进行 Meta 分析。结果共纳入20个 RCT，合计1649例患者。Meta 分析结果显示：（1）VAS 评分：与单用布托啡诺组比较，联合用药组在术后12、24及48 h VAS 评分均降低，且均有统计学意义（P ＜0．05）；与单用芬太尼组比较，联合用药组术后48 h VAS 评分降低[WMD ＝－0．11，95％CI（－0．20，－0．01），P ＝0．03]；（2）Ramsay 评分：与单用布托啡诺组比较，联合用药组在术后48 h RSS 评分较高，且有统计学意义；与单用芬太尼组比较，联合用药组术后 RSS 评分仅12 h 有统计学意义；（3）安全性：联合用药组术后恶心呕吐、头晕、皮肤瘙痒及总发生率较布托啡诺组或芬太尼组明显降低。结论与单用布托啡诺组或芬太尼相比，布托啡诺联合芬太尼用于术后 PCIA 均能获得良好的镇痛镇静效果，患者术后不良反应的发生率降低，临床应用更安全。
목적：평개포탁배낙연합분태니술후정맥자공진통（PCIA）적림상효과여안전성。방법계산궤검색 PubMed、ISI、CBM、CNKI 화 VIP，수집포탁배낙연합분태니술후정맥자공진통적수궤대조시험（RCT），채용 RevMan 5．2연건대 VAS 평분、RSS 평분、불량반응진행 Meta 분석。결과공납입20개 RCT，합계1649례환자。Meta 분석결과현시：（1）VAS 평분：여단용포탁배낙조비교，연합용약조재술후12、24급48 h VAS 평분균강저，차균유통계학의의（P ＜0．05）；여단용분태니조비교，연합용약조술후48 h VAS 평분강저[WMD ＝－0．11，95％CI（－0．20，－0．01），P ＝0．03]；（2）Ramsay 평분：여단용포탁배낙조비교，연합용약조재술후48 h RSS 평분교고，차유통계학의의；여단용분태니조비교，연합용약조술후 RSS 평분부12 h 유통계학의의；（3）안전성：연합용약조술후악심구토、두훈、피부소양급총발생솔교포탁배낙조혹분태니조명현강저。결론여단용포탁배낙조혹분태니상비，포탁배낙연합분태니용우술후 PCIA 균능획득량호적진통진정효과，환자술후불량반응적발생솔강저，림상응용경안전。
Objective To evaluate the efficacy and safety of butorphanol combined with fentanyl for patient -controlled analgesia (PCA).Methods The randomized controlled trials of butorphanol combined with fentanyl for PCA were gathered from PubMed,ISI, CBM,CNKI and VIP Data.After data extraction and quality assessment of the included RCTs,the RevMan 5.2 software was applied for meta -analysis of visual analog scale(VAS)score,Ramsay score and safety.Results A total of 20 RCTs involving 1649 patients were included.The results of meta -analyses showed that:① as for visual analog scale(VAS)score,compared with the butorphanol group, the combination group had significant differences at 12 -hour,24 -hour and 48 -hour post -operation,and the VAS of post -operation at 48 hours was decreased when compared with fentanyl group(WMD =-0.11,95%CI -0.20 to -0.01,P =0.03);② as for Ram-say sedation score,compared with the butorphanol group,the Ramsay score at 48 -hour post -operation was decreased when butorpha-nol combined with fentanyl for PCA,and there were significant differences in Ramsay score of 12 -hour post -operation between the combination group and the single fentanyl group;③ as for adverse reaction,in the combination group compared with the single fentanyl or butorphanol group,nausea,vomiting,drowsiness and incidence of adverse reactions were significantly reduced.Conclusions Ac-cording to the domestic evidence,butorphanol combined with fentanyl for PCA could effectively alleviate post -operative pain compared with butorphanol or fentanyl alone,and can be able to reduce the incidence of adverse reactions.