摘要
目的:系统评价在终末期肾脏病病人行PDC置入术术中和术后镇痛中腹横肌平面阻滞(TAPB)与局部浸润麻醉的有效性和安全性的比较。方法:使用计算机检索EMbase、The Cochrane Library、Wan Fang Data、CNKI、Pub Med和VIP等数据库,搜集公开发表的有关腹横肌平面阻滞(TAPB)和切口局部浸润应用于腹膜透析导管置入术比较的随机对照试验(RCT),检索时限均从建库至2020年9月30日。由2名研究员独立进行文献内容筛选、资料提取等,评估文献偏倚风险,使用Rev Man 5.3软件进行Meta分析。结果共纳入5个RCT,包括244例患者,比较试验组与对照组术中麻醉操作、手术切皮、分离肌肉组织、分离皮下组织、置放腹膜透析管、牵拉及切开腹膜、打皮下隧道缝皮时以及术后2h和24h的疼痛视觉模拟评分(VAS)情况;术后24h追加芬太尼药物累计用量;恶心、呕吐发生率。结果:Meta分析结果显示:试验组术中术后的VAS均低于对照组,24h内芬太尼用量少于对照组(MD=-2.67,95%CI-3.22~-2.12,P<0.01),恶心呕吐发生率对比无差异(P>0.05)。结论:TAP阻滞可减轻患者术中术后的疼痛程度,一定程度减少麻醉用量,是一种安全有效的麻醉方法,但有待进一步高质量研究验证。
Objective:To systematically evaluate the effectiveness and safety comparison of abdominal transverse muscle plane block(TAPB)and local infiltration anesthesia in intraoperative and postoperative analgesia of patients with end-stage renal disease who received PDC surgery.Methods:The EMbase,the Cochrane Library,Wan Fang Data,CNKI,Pub Med,and VIP databases were searched by computers,the publicly published randomized controlled tests(RCT)of comparison of abdominal transverse muscle plane block(TAPB)and local infiltration of the incision for peritoneal dialysis catheterization were collected,and the retrieval time was from library construction to September 30,2020.Two researchers independently screened the literature content and conducted data extraction to assess the risk of literature bias,and Meta-analysis was performed using Rev Man 5.3 software.A total of five RCTs including 244 patients were included.The pain visual simulation scores(VAS)at anesthesia,surgical peeling,muscle tissue separation,subcutaneous tissue separation,peritoneal dialysis catheterization,pulling and opening the peritoneum,subcutaneous tunnel suture,and 2h and 24h after surgery,the cumulative amount of additional fentanyl drug dosage 24h after surgery,and the incidence of nausea and vomiting were compared between the study group and control group.Results:Meta-analysis showed that postoperative VAS scores in the study group were all lower than those in the control group,and the fentanyl dosage within 24h was less than that in the control group(MD=-2.67,95%CI-3.22~-2.12,P<0.01).There was no difference in the incidence of nausea and vomiting(P>0.05).Conclusion:TAP block can reduce the degree of postoperative pain in patients and reduce the dosage of anesthesia to some extent,which is a safe and effective anesthesia method,but it needs to be verified by further high-quality studies.
作者
张鹏远
刘瑞华
王振华
韩国瑞
袁毅
Zhang Pengyuan;Liu Ruihua;Wang Zhenhua;Han Guorui;Yuan Yi(Department of Kidney Disease,Rheumatology and Immunology,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000)
出处
《数理医药学杂志》
CAS
2022年第3期368-372,共5页
Journal of Mathematical Medicine
关键词
腹横肌平面阻滞
TAPB
腹膜透析
META分析
transverse abdominal muscle plane block
TAPB
peritoneal dialysis
Meta analysis
