TPVB对全身麻醉下CABG患者术后镇痛效果的影响:meta分析
Effect of thoracic paravertebral nerve block on postoperative analgesia in patients undergoing CABG under general anesthesia:a meta-analysis
徐宁 1毕明超 1荣伟1
作者信息
- 1. 青岛大学附属威海市中心医院麻醉科,威海 264400
- 折叠
摘要
目的 采用meta分析评价双侧胸椎旁神经阻滞(TPVB)对全身麻醉下冠状动脉搭桥术(CABG)患者术后镇痛效果的影响.方法 系统检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方医学网和维普资讯数据库,限定检索时间截止至2023年12月.纳入双侧TPVB联合全身麻醉与单纯全身麻醉比较CABG患者术后镇痛效果的随机对照试验.主要结局指标:术后24 h内补救镇痛率;次要结局指标:术中阿片类药物用量和不良反应发生率、术后恢复指标和术后不良反应发生率.应用R studio软件调用"meta"程序包进行meta分析.结果 共纳入9篇文献(n=788).与全身麻醉相比,双侧TPVB联合全身麻醉可减少术中阿片类药物用量(SMD=-1.88,95％CI-2.80～-0.96),降低术后24 h内补救镇痛率(RR=0.17,95％CI 0.06～0.46)和术后不良反应发生率(RR=0.39,95％CI 0.25～0.60),缩短术后气管拔管时间(MD=-1.52,95％CI-2.01～-1.03)、术后 ICU 停留时间(MD=-4.40,95％CI-5.29～-3.51)和术后住院时间(MD=-0.70,95％CI-1.37～-0.04).结论 双侧TPVB可增强全身麻醉下CABG患者术后镇痛的效果.
Abstract
Objective To systematically review the effect of bilateral thoracic paravertebral nerve block(TPVB)on postoperative analgesia in the patients undergoing coronary artery bypass grafting(CABG)under general anesthesia(GA)using a meta-analysis.Methods A systematic search of PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang,and VIP databases was performed,with a limited search period ending in December 2023.Randomized con-trolled trials regarding bilateral TPVB combined with GA versus GA alone for postoperative analgesia follow-ing CABG were included.The primary outcome was the rate of 24 h postoperative rescue analgesia.Seconda-ry outcomes were intraoperative opioid consumption,incidence of intraoperative adverse reactions,indicators related to postoperative recovery,and incidence of postoperative adverse reactions.This meta-analysis was performed by using the"meta"package in R studio software.Results A total of 9 papers(n=788)were included.Compared to GA,bilateral TPVB combined with GA reduced intraoperative opioid consumption(SMD=-1.88,95％confidence interval[CI]-2.80--0.96),decreased the rate of 24 h postoperative res-cue analgesia(RR=0.17,95％CI 0.06-0.46)and the incidence of postoperative adverse reactions(RR=0.39,95％CI 0.25-0.60)and shortened postoperative extubation time(MD=-1.52,95％CI-2.01--1.03),postoperative intensive care unit stay(MD=-4.40,95％CI-5.29--3.51)and postoperative hos-pitalization time(MD=-0.70,95％CI-1.37--0.04).Conclusions Bilateral TPVB can enhance the postoperative analgesic effect in the patients undergoing CABG under general anesthesia.
关键词
神经传导阻滞/胸椎/麻醉,全身/冠状动脉旁路移植术/镇痛,病人控制/Meta分析Key words
Nerve block/Thoracic vertebrae/Anesthesia,general/Coronary artery bypass/Analgesia,patient-controlled/Meta-analysis引用本文复制引用
出版年
2024
NETL
NSTL
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