硬膜外鎮痛對腸道手術預后影響的Meta分析_《中國循證醫學雜志》

作者：

夏海發 , 任許利 , 王韶雙 ,  呂黃偉

中國醫科大學附屬第一醫院麻醉科（沈陽?110001）;

關鍵詞：

硬膜外鎮痛腸道手術 Meta分析

DOI：

10.7507/1672-2531.20110158

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目的　系統評價硬膜外鎮痛對腸道手術預后的影響。
方法　計算機檢索PubMed、EBSCO、Springer、Ovid、CNKI和CBM數據庫，納入1985～2010年間發表的關于腸道手術應用硬膜外鎮痛對術后胃腸功能影響的隨機對照試驗（RCT），按Cochrane系統評價方法對納入文獻進行資料提取和質量評價，而后采用RevMan 5.0軟件進行Meta分析。
結果　共納入10個RCT，包括506例患者。納入RCT質量均為C級。Meta分析結果顯示：硬膜外自控鎮痛與傳統靜脈自控鎮痛相比，術后首次排氣、首次排便和住院時間均縮短［MD（95%CI）分別為–1.07（–1.63，–0.50）、–0.63（–1.19，–0.08）和–1.36（–2.28，–0.44）］。術后第1和第2天嘔吐發生率降低［OR（95%CI）分別為0.33（0.13，0.82）和0.32（0.13，0.84）］。術后第1、2和3天靜息痛VAS［MD（95%CI）分別為–26.60（–33.06，–20.15）、–25.98（–30.98，–20.97）和–15.59（–27.29，–3.88）］，運動痛VAS［MD（95%CI）分別為–26.00（–36.00，–16.00）、–27.89（–35.70，–20.08）和-11.79（–21.28，–2.30）］均明顯降低。而在術后尿道感染、尿潴留、吻合口漏和腸梗阻發生率方面，兩者間差異無統計學意義。
結論　腸道手術術后應用硬膜外自控鎮痛較之傳統靜脈自控鎮痛能明顯縮短首次排氣、排便和術后住院時間，且能明顯降低術后疼痛VAS，降低術后嘔吐發生率。但本研究納入RCT質量均低，樣本量小，結論尚需大規模高質量RCT證實。

引用本文： 夏海發,任許利,王韶雙,呂黃偉. 硬膜外鎮痛對腸道手術預后影響的Meta分析. 中國循證醫學雜志, 2011, 11(8): 946-953. doi: 10.7507/1672-2531.20110158 復制

1.	1 Cali RL, Meade PG, Swanson MS, et al . Effect of morphine and incision length on bowel function after colectomy. Dis Colon Rectum , 2000, 43(2): 163-168.
2.	Liu S, Carpenter RL, Neal JM, et al . Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology , 1995, 82(6): 1474-1506.
3.	Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci , 1990, 35: 121-131.
4.	Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surgery , 2003, 238(5): 663-673.
5.	Rockemann MG, Seeling W, Goertz AW, et al . Effectiveness, side effects and costs of postoperative pain therapy: intravenous and epidural patient-controlled analgesia (PCA). Anasthesiol Intensivmed Notfallmed Schmerzther , 1997, 32(7): 414-419.
6.	Thompson JS. The role of epidural analgesia and anesthesia in surgical outcomes. Adv Surg , 2002, 36(4): 297-307.
7.	Waurick R, Van AH. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol , 2005, 19(2): 201-213.
8.	ParkWY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg , 2001, 234(4): 560-569.
9.	Peyton PJ, Myles PS, Silbert BS, et al . Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. Anesth Analg , 2003, 96(2): 548-554.
10.	Urs Z, Danilo M, Christian T, et al . Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection. Surg Endosc , 2009, 23(2): 276-282.
11.	Taqi X, Hong G, Mistraletti G, et al . Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc , 2007, 21(2): 247-252.
12.	Carli F, Mayo N, Klubien K, et al . Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology , 2002, 97(3): 540-549.
13.	Paulsen EK, Porter MG, Helmer SD, et al . Thoracic epidural versus patient-controlled analgesia in elective bowel resections. The American Journal of Surgery , 2007, 182(6): 570-577.
14.	Carli F, Trudel JL, Belliveau P, et al . The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: A prospective randomized trial. Dis Colon Rectum , 2001, 44(8): 1083-1089.
15.	Claude M, Yvan P, Gilles B, et al . Comparison of Intravenous or Epidural Patientcontrolled Analgesia in the Elderly after Major Abdominal Surgery. Anesthesiology , 2000, 92(2): 433-441.
16.	李芳, 孔德玲, 趙道霞. PCIA 與PCEA 對下腹部手術后患者功能恢復影響的對比研究. 山西醫科大學學報, 2007, 38(9): 842-844.
17.	徐紅梅, 張躍, 錢燕寧. 賁門癌根治術中兩種麻醉鎮痛方案對病人術后康復的影響及其醫療費用比較. 實用臨床醫藥雜志, 2008, 12(7): 37-42.
18.	洪溪, Carli F, 黃宇光, 等. 手術及鎮痛方式對腸道手術后功能恢復的影響. 臨床麻醉學雜志, 2006, 22(5): 334-336.
19.	王剛, 江志偉, 沈蓓, 等. 胸段硬膜外鎮痛對腹腔鏡結直腸手術后疼痛和腸功能的影響. 醫學研究生學報, 2010, 23(8): 830-833.
20.	劉建湘, 劉新光. 外科手術后的胃腸動力障礙. 中國實用內科雜志, 2001, 21(10): 591-593.
21.	劉志雙, 李星, 劉順鎖, 等. 剖宮產手術后硬膜外腔持續鎮痛效果及對泌乳和腸蠕動的影響. 中華麻醉學雜志, 2003, 23(1): 64-65.
22.	Scott AM, Starling JR, Ruscher AE. Thoracic versus lumbar epidural anesthesia’s effect on pain control and ileus resolustion after restorative proctocolectomy. Surgery , 1996, 120(4): 688-697.
23.	Bredtmann RD, Herden HN, Teichmann W, et al . Epidural analgesia in colonic surgery: results of a randomized prospective study. Br J Surg , 1990, 77(6): 638-642.

1. 1 Cali RL, Meade PG, Swanson MS, et al . Effect of morphine and incision length on bowel function after colectomy. Dis Colon Rectum , 2000, 43(2): 163-168.
2. Liu S, Carpenter RL, Neal JM, et al . Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology , 1995, 82(6): 1474-1506.
3. Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci , 1990, 35: 121-131.
4. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surgery , 2003, 238(5): 663-673.
5. Rockemann MG, Seeling W, Goertz AW, et al . Effectiveness, side effects and costs of postoperative pain therapy: intravenous and epidural patient-controlled analgesia (PCA). Anasthesiol Intensivmed Notfallmed Schmerzther , 1997, 32(7): 414-419.
6. Thompson JS. The role of epidural analgesia and anesthesia in surgical outcomes. Adv Surg , 2002, 36(4): 297-307.
7. Waurick R, Van AH. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol , 2005, 19(2): 201-213.
8. ParkWY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg , 2001, 234(4): 560-569.
9. Peyton PJ, Myles PS, Silbert BS, et al . Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. Anesth Analg , 2003, 96(2): 548-554.
10. Urs Z, Danilo M, Christian T, et al . Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection. Surg Endosc , 2009, 23(2): 276-282.
11. Taqi X, Hong G, Mistraletti G, et al . Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc , 2007, 21(2): 247-252.
12. Carli F, Mayo N, Klubien K, et al . Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology , 2002, 97(3): 540-549.
13. Paulsen EK, Porter MG, Helmer SD, et al . Thoracic epidural versus patient-controlled analgesia in elective bowel resections. The American Journal of Surgery , 2007, 182(6): 570-577.
14. Carli F, Trudel JL, Belliveau P, et al . The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: A prospective randomized trial. Dis Colon Rectum , 2001, 44(8): 1083-1089.
15. Claude M, Yvan P, Gilles B, et al . Comparison of Intravenous or Epidural Patientcontrolled Analgesia in the Elderly after Major Abdominal Surgery. Anesthesiology , 2000, 92(2): 433-441.
16. 李芳, 孔德玲, 趙道霞. PCIA 與PCEA 對下腹部手術后患者功能恢復影響的對比研究. 山西醫科大學學報, 2007, 38(9): 842-844.
17. 徐紅梅, 張躍, 錢燕寧. 賁門癌根治術中兩種麻醉鎮痛方案對病人術后康復的影響及其醫療費用比較. 實用臨床醫藥雜志, 2008, 12(7): 37-42.
18. 洪溪, Carli F, 黃宇光, 等. 手術及鎮痛方式對腸道手術后功能恢復的影響. 臨床麻醉學雜志, 2006, 22(5): 334-336.
19. 王剛, 江志偉, 沈蓓, 等. 胸段硬膜外鎮痛對腹腔鏡結直腸手術后疼痛和腸功能的影響. 醫學研究生學報, 2010, 23(8): 830-833.
20. 劉建湘, 劉新光. 外科手術后的胃腸動力障礙. 中國實用內科雜志, 2001, 21(10): 591-593.
21. 劉志雙, 李星, 劉順鎖, 等. 剖宮產手術后硬膜外腔持續鎮痛效果及對泌乳和腸蠕動的影響. 中華麻醉學雜志, 2003, 23(1): 64-65.
22. Scott AM, Starling JR, Ruscher AE. Thoracic versus lumbar epidural anesthesia’s effect on pain control and ileus resolustion after restorative proctocolectomy. Surgery , 1996, 120(4): 688-697.
23. Bredtmann RD, Herden HN, Teichmann W, et al . Epidural analgesia in colonic surgery: results of a randomized prospective study. Br J Surg , 1990, 77(6): 638-642.

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硬膜外鎮痛對腸道手術預后影響的Meta分析

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《中國循證醫學雜志》

硬膜外鎮痛對腸道手術預后影響的Meta分析

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