摘要
目的评价前锯肌平面阻滞(serratus anterior plane block,SAPB)用于减轻胸腔镜术后阿片类药物所致恶心呕吐的有效性和安全性。方法计算机检索PubMed、Ovid、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SAPB用于胸腔镜术后镇痛的随机对照试验(RCT),对照组为注入安慰剂或不阻滞,检索时间均从建库至2019年12月。2位研究者按照纳入标准筛选文献、提取资料,2位评价员独立对纳入文献的质量进行评价,采用RevMan5.3进行meta分析。结果纳入12个RCT共703例患者。在有效性方面,与对照组相比,SAPB组术后各时点静息状态、运动状态下疼痛视觉模拟评分(Visual Analogue Scale,VAS)降低,差异有统计学意义;在安全性方面,与对照组相比,SAPB组术后恶心呕吐发生率较低,差异有统计学意义(RR=0.36,95%CI:0.20~0.65,P=0.0006),SAPB组术后24 h吗啡累积使用量较少,差异有统计学意义(MD=-1.51,95%CI:-1.93^-1.10,P<0.00001)。结论SAPB能够降低胸腔镜术后恶心呕吐发生率,减少术后阿片类镇痛药物的使用,用于胸腔镜术后镇痛安全有效。
Objective To evaluate the efficacy and safety of ultrasound-guided serratus anterior plane block(SAPB)on alleviating opioid-induced nausea and vomiting in patients undergoing video-assisted thoracoscopic surgery(VATS).Methods The PubMed database,Ovid,Cochrane Library,ISI Web of knowledge,CBM database,VIP database,CNKI database and Wanfang database were searched from their start year up to December 2019 for relevant randomized clinical trials(RCT)that compared SAPB to sham block or non-block care for postoperative analgesia.Randomized clinical trials met the inclusion criteria were screened and included,and meta-analysis was conducted by using the Cochrane CoHaboration’s RevMan5.3 software.Results Twelve studies involving 703 patients were included in this meta-analysis.Compared with the control group,the Visual Analogue Scale(VAS)score under rest or exercise status in the SAPB group was lower,with statistically significant difference.In terms of safety,as compared with the control group,the incidence of postoperative nausea and vomiting was lower in the SAPB group,with statistically significant difference(RR=0.36,95%CI:0.20 to 0.65,P=0.0006).The cumulative consumption of morphine in the SAPB group after 24 h was smaller,with statistically significant difference(MD=-1.51,95%CI:-1.93 to-1.10,P<0.00001).ConclusionsSAPB can reduce the incidence of nausea and vomiting after thoracoscopic surgery and reduce the use of opioid analgesics after surgery.It is safe and effective for analgesia after thoracoscopic surgery.
作者
郝泉水
卢柱
李太子
吴耀华
付丽莎
Hao Quanshui;Lu Zhu;Li Taizi(Department of Anesthesiology, Huanggang Central Hospital, Huanggang 438000, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第9期775-779,共5页
Chinese Journal of Minimally Invasive Surgery
基金
黄冈市科技计划项目(XQYF2019000014)
湖北省卫生计生科研基金(WJ2016-YZ-11)。
关键词
前锯肌平面阻滞
胸腔镜手术
术后恶心呕吐
术后镇痛
META分析
Serratus anterior plane block
Video-assisted thoracoscopic surgery
Postoperative nausea and vomiting
Postoperative analgesia
Meta-analysis
作者简介
通讯作者:付丽莎,E-mail:flsh2020@sina.com。
