摘要
目的评价腹横肌平面(TAP)阻滞在结直肠癌根治术后镇痛的效果。方法文献检索万方数据库、中国期刊全文数据库、中国生物医学文献数据库、维普、Cochrane library及Pub Med数据库,广泛收集国内外已公开发表的有关结直肠癌根治术使用TAP阻滞镇痛的临床随机对照试验。按照纳入及排除标准进行文献筛选、资料提取、质量评价。本分析共纳入10项研究552例患者,其中试验组278例、对照组274例。采用Rev Man 5.3软件行统计学处理,比较试验组与对照组术后2 h、4 h、8 h、12 h、24 h以及48 h的疼痛视觉模拟评分(VAS)情况,镇痛泵按压次数,术后24 h内芬太尼用量,患者镇痛满意度,住院时间以及恶心呕吐的发生率。结果 Meta分析结果显示:试验组术后2 h、4 h、8 h、12 h、24 h以及48 h的VAS低于对照组,镇痛泵按压次数少于对照组(WMD=-2.75,95%CI-3.11^-2.39,P<0.01)和24 h内芬太尼用量少于对照组(WMD=-2.53,95%CI-2.87^-2.19,P<0.01),镇痛满意度高于对照组(WMD=2.17,95%CI 1.64~2.71,P<0.01),恶心呕吐发生率低于对照组(WMD=0.52,95%CI 0.29~0.95,P<0.05),住院时间比较差异无统计学意义(P>0.05)。结论 TAP阻滞能减轻患者术后疼痛,减少镇痛泵按压次数,减少麻醉镇痛药用量,提高患者满意度,降低恶心呕吐发生率,且不会增加住院时间,具有较好的临床效益。
Objective To evaluate the effect of transversus abdominis plane（TAP） block on analgesia after radical resection of colorectal cancer. Methods Literatures were retrieved from databases including Wab.fang data, CNKI, CBM, cqvip, Cochrane Libranry and PubMed. Collecting relevant randomized clinical trials published at home and abroad about colorectal cancer radical resection using TAP block analgesia. Data extracting and quality evaluation were conducted accord- ing to the inclusion and exclusion criteria. A total of 10 studies and $52 patients were selected in this study, of which,278 were in the trial group and 274 were in the control group. The RevMan 5.3 software was applied for statistical analysis, and the visual analogue scale （VAS） of postoperative 2 h,4h, 8 h, 12h, 24h and 48h, analgesia pressing times, postoperative fentanyl dosage in 24 h, patient satisfaction, hospitalization time and the incidence of nausea and vomiting in the two groups were compared. Results Meta-analysis showed that, the VAS postoperative 2 h,4 h, 8 h, 12 h,24 h and 48 h of the trial group were less than those of the control group, the analgesia pressing times （ WMD = - 2.75,95 % CI - 3.11- - 2.39, P 〈 0.01 ） and ihe postoperative fentanyl dosage in 24 h （ WMD = - 2.53,95% CI - 2.87-2.19 ,P〈 0.01 ） of the trial group were less than those of the control group, the patient satisfaction （ WMD = 2.17,95% CI 1.64-2.71, p 〈 0.01 ） of the trial group was higher than that of the control group, the incidence of nausea and vomiting （ WMD =0. 52,95 % CI 0. 29-0.95,P 〈 0.05） of the trial group was lower than that of the control group. The hospitalization time of the two groups had no statistical difference（ P 〉 0.05）. Conclusion TAP block can reduce postoperative pain, analgesia pump demanding times and the consumption of narcotic, improving the patients＇ satisfaction, reducing the incidence of nausea and vomiting, without increasing the length of hospital stay. With such clinical benefits.
出处
《医学综述》
2017年第22期4549-4555,共7页
Medical Recapitulate
关键词
结直肠癌
腹横肌平面阻滞
镇痛
局部麻醉
Colorectal cancer
Transversus abdominis plane block
Analgesia
Local anesthesia
作者简介
通信作者E-mail：hulizym@yeah．net
