摘要
目的系统评价芬太尼透皮贴剂对比口服吗啡治疗中重度癌痛的效果。方法计算机检索h e Cochrane Library(2014年第1期)、Pub Med、Web of Science、CNKI、VIP、CBM和Wan Fang Data数据库,纳入芬太尼透皮贴剂对比口服吗啡治疗中重度癌痛的随机对照试验(RCT),检索时限截至2014年1月。由2位研究者按照纳入与排除标准独立进行文献筛选、资料提取和评价纳入研究的方法学质量后,采用Rev Man 5.1.0软件进行Meta分析。结果共纳入35个RCT,3 406例患者。Meta分析结果显示,芬太尼透皮贴剂与口服吗啡镇痛效果差异无统计学意义[OR=1.00,95%CI(0.80,1.27),P=0.99]。与口服吗啡相比,芬太尼透皮贴剂组患者的便秘、恶心呕吐、嗜睡和尿潴留的发生率明显较低(P<0.05),但皮肤刺激症状发生率明显增高(P<0.05)。结论芬太尼透皮贴剂在治疗中重度癌痛方面效果与口服吗啡相当,且不良反应更少。但受纳入研究质量的限制,本研究结论尚需进一步开展更多高质量的RCT进行验证。
Objective To systematically review the efficacy of transdermal fentanyl versus oral morphine for mod- erate/severe cancer pain. Methods Databases such as The Cochrane Library （Issue 1, 2014）, PubMed, Web of Science, CNKI, VIP, CBM and WanFang Data were searched for randomized controlled trials （RCTs） on the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain up to January 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1.0 software. Results A total of 35 RCTs involved 3 406 patients were included. The results of meta-analysis showed that, there was no significant difference in effectiveness between transdermal fentanyl and oral morphine for moderate/severe cancer pain （OR=1.00, 95%CI 0.80 to 1.27, P=0.99）. Compared with oral morphine, transdermal fentanyl was better in lowering the incidences of constipation, nausea and vomiting, lethargy and urinary retention; but transdermal fentanyl increased the incidences of skin rashes and itch （P〈0.05）. Conclusion Transdermal fentanyl is as effective as oral morphine in the treatment of moderate/severe cancer pain, and transdermal fentanyl causes less side effects. Due to poor quality of the included studies, the above conclusion should be verified by further conducting more high quality RCTs.
出处
《中国循证医学杂志》
CSCD
2014年第11期1380-1388,共9页
Chinese Journal of Evidence-based Medicine
关键词
芬太尼透皮贴剂
吗啡
癌痛
系统评价
META分析
随机对照试验
Transdermal fentanyl
Oral morphine
Cancer pain
Systematic review
Meta-analysis
Randomizedcontrolled trial
