硫酸鎂對全麻術后疼痛和并發癥影響的Meta分析_《中國循證醫學雜志》

作者：

尹秀茹 ,  裴凌

中國醫科大學附屬第一醫院麻醉科（沈陽 110001）;

關鍵詞：

硫酸鎂疼痛全身麻醉 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20120054

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目的　系統評價硫酸鎂對全麻術后疼痛和并發癥的影響。
方法　計算機檢索Cochrane圖書館、EMbase、PubMed、EBSCO、Springer、Ovid、CNKI、CBM等數據庫，收集從建庫至2011年9月間關于全身麻醉中靜脈應用硫酸鎂的隨機對照試驗（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后，采用RevMan 5.1軟件進行統計分析。
結果　共納入11個RCT，包括905例患者。Meta分析結果顯示：與對照組相比，全身麻醉中靜脈應用硫酸鎂能顯著降低患者術后2、4、6、8、16及24小時各時點的疼痛視覺模擬（VAS）評分，減少術后24小時的嗎啡用量，降低術后惡心嘔吐［RR=0.61，95%CI（0.40，0.91），P=0.02］及寒戰［RR=0.29，95%CI（0.14，0.59），P=0.000 7］的發生率；心動過緩的發生率［RR=1.93，95%CI（1.05，3.53），P=0.03］雖有所增加，但未造成不良后果，且兩組在低血壓發生率和血鎂濃度變化方面的差異無統計學意義。
結論　全身麻醉中靜脈應用硫酸鎂能明顯降低患者術后疼痛程度，降低術后惡心嘔吐及寒戰的發生率，且不增加心血管不良事件和高鎂血癥的風險。但上述結果尚需更多高質量、大樣本的隨機對照試驗進一步驗證。

引用本文： 尹秀茹,裴凌. 硫酸鎂對全麻術后疼痛和并發癥影響的Meta分析. 中國循證醫學雜志, 2012, 12(3): 334-340. doi: 10.7507/1672-2531.20120054 復制

1.	Soave PM, Conti G, Costa R, et al. Magnesium and anaesthesia. Current Drug Targets, 2009, 10(8): 734-743.
2.	Barbosa FT, Barbosa LT, Jucá MJ, et al. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol, 2010, 60(1): 104-110.
3.	Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology, 2001, 95(3): 640-646.
4.	Higgins JPT, Altman DG and Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.cochrane-handbook.org.
5.	Kiran S, Gupta R, Verma D. Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery. Indian J Anaesth, 2011, 55(1): 31-35.
6.	Kaya S, Kararmaz A, Gedik R, et al. Magnesium sulfate reduces postoperative morphine requirement after remifentanil-based anesthesia. Med Sci Monit, 2009, 15(2): 15-19.
7.	Mentes O, Harlak A, Yigit T, et al. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2008, 52(10): 1353-1359.
8.	Ferasatkish R, Dabbagh A, Alavi M, et al. Effect of magnesium sulfate on extubation time and acute pain in coronary artery bypass surgery. Acta Anaesthesiol Scand, 2008, 52(10): 1348-1352.
9.	Ryu JH, Kang MH, Park KS, et al. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth, 2008, 100(3): 397-403.
10.	Tramèr MR, Glynn CJ. An evaluation of a single dose of magnesium to supplement analgesia after ambulatory surgery: randomized controlled trial. Anesth Analg, 2007, 104(6): 1374-1379.
11.	Cizmeci P, Ozkose Z. Magnesium sulphate as an adjuvant to total intravenous anesthesia in septorhinoplasty: a randomized controlled study. Aesthetic Plast Surg, 2007, 31(2): 167-173.
12.	Tauzin-Fin P, Sesay M, Delort-Laval S, et al. Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy. Eur J Anaesthesiol, 2006, 23(12): 1055-1059.
13.	Bhatia A, Kashyap L, Pawar DK, et al. Effect of intraoperative magnesium infusion on perioperative analgesia in open cholecystectomy. J Clin Anesth, 2004, 16(4): 262-265.
14.	Levaux Ch, Bonhomme V, Dewandre PY, et al. Effect of intra-operative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia, 2003, 58(2): 131-135.
15.	譚天云, 胡興國, 肖亞芬, 等. 硫酸鎂對腹腔鏡膽囊摘除術術后疼痛的影響. 醫學臨床研究, 2006, 23(12): 1922-1924.
16.	Hollmann MW, Liu HT, Hoenemann CW, et al. Modulation of NMDA receptor function by ketamine and magnesium.Part II: interactions with volatile anesthetics. Anesth Analg, 2001, 92(5): 1182-1191.
17.	Kara H, Sahin N, Ulusan V, et al. Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol, 2002, 19(1): 52-56.
18.	Telci L, Esen F, Akcora D, et al. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth, 2002, 89(4): 594-598.
19.	Oguzhan N, Gunday I, Turan A. Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag, 2008, 4(2): 105-110.
20.	Zarauza R, Sáez-Fernández AN, Iribarren M, et al. A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia. Anesth Analg, 2000, 91(4): 938-943.
21.	Schulz-Stübner S, Wettmann G, Reyle-Hahn SM, et al. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. Eur J Anaesthesiol, 2001, 18(11): 723-729.
22.	Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anesth, 2003, 50(7): 732- 746.
23.	Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate. Br J Anaesth, 2009, 103(4): 490-495.
24.	Parra L, Fita G, Gomar C, et al. Plasma magnesium in patients submitted to cardiac surgery and its influence on perioperative morbidity. J Cardiovasc Surg (Torino), 2001, 42(1): 37-42.

1. Soave PM, Conti G, Costa R, et al. Magnesium and anaesthesia. Current Drug Targets, 2009, 10(8): 734-743.
2. Barbosa FT, Barbosa LT, Jucá MJ, et al. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol, 2010, 60(1): 104-110.
3. Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology, 2001, 95(3): 640-646.
4. Higgins JPT, Altman DG and Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.cochrane-handbook.org.
5. Kiran S, Gupta R, Verma D. Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery. Indian J Anaesth, 2011, 55(1): 31-35.
6. Kaya S, Kararmaz A, Gedik R, et al. Magnesium sulfate reduces postoperative morphine requirement after remifentanil-based anesthesia. Med Sci Monit, 2009, 15(2): 15-19.
7. Mentes O, Harlak A, Yigit T, et al. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2008, 52(10): 1353-1359.
8. Ferasatkish R, Dabbagh A, Alavi M, et al. Effect of magnesium sulfate on extubation time and acute pain in coronary artery bypass surgery. Acta Anaesthesiol Scand, 2008, 52(10): 1348-1352.
9. Ryu JH, Kang MH, Park KS, et al. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth, 2008, 100(3): 397-403.
10. Tramèr MR, Glynn CJ. An evaluation of a single dose of magnesium to supplement analgesia after ambulatory surgery: randomized controlled trial. Anesth Analg, 2007, 104(6): 1374-1379.
11. Cizmeci P, Ozkose Z. Magnesium sulphate as an adjuvant to total intravenous anesthesia in septorhinoplasty: a randomized controlled study. Aesthetic Plast Surg, 2007, 31(2): 167-173.
12. Tauzin-Fin P, Sesay M, Delort-Laval S, et al. Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy. Eur J Anaesthesiol, 2006, 23(12): 1055-1059.
13. Bhatia A, Kashyap L, Pawar DK, et al. Effect of intraoperative magnesium infusion on perioperative analgesia in open cholecystectomy. J Clin Anesth, 2004, 16(4): 262-265.
14. Levaux Ch, Bonhomme V, Dewandre PY, et al. Effect of intra-operative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia, 2003, 58(2): 131-135.
15. 譚天云, 胡興國, 肖亞芬, 等. 硫酸鎂對腹腔鏡膽囊摘除術術后疼痛的影響. 醫學臨床研究, 2006, 23(12): 1922-1924.
16. Hollmann MW, Liu HT, Hoenemann CW, et al. Modulation of NMDA receptor function by ketamine and magnesium.Part II: interactions with volatile anesthetics. Anesth Analg, 2001, 92(5): 1182-1191.
17. Kara H, Sahin N, Ulusan V, et al. Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol, 2002, 19(1): 52-56.
18. Telci L, Esen F, Akcora D, et al. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth, 2002, 89(4): 594-598.
19. Oguzhan N, Gunday I, Turan A. Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag, 2008, 4(2): 105-110.
20. Zarauza R, Sáez-Fernández AN, Iribarren M, et al. A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia. Anesth Analg, 2000, 91(4): 938-943.
21. Schulz-Stübner S, Wettmann G, Reyle-Hahn SM, et al. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. Eur J Anaesthesiol, 2001, 18(11): 723-729.
22. Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anesth, 2003, 50(7): 732- 746.
23. Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate. Br J Anaesth, 2009, 103(4): 490-495.
24. Parra L, Fita G, Gomar C, et al. Plasma magnesium in patients submitted to cardiac surgery and its influence on perioperative morbidity. J Cardiovasc Surg (Torino), 2001, 42(1): 37-42.

《中國循證醫學雜志》

硫酸鎂對全麻術后疼痛和并發癥影響的Meta分析

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《中國循證醫學雜志》

硫酸鎂對全麻術后疼痛和并發癥影響的Meta分析

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