根据知觉水平指数指导的阿片类药物管理是否可以减少手术期间的阿片类药物消费? 一个系统的审查和元分析.
Muhammet Selman Sogut1, Ilayda Kalyoncu1, Muhammet Ahmet Karakaya2
1From the Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey.
Anesthesia and analgesia
|August 2, 2024
概括
在这次元分析中,知觉水平 (NOL) 监测并没有显著减少手术内阿片类药物使用. 有证据表明,NOL监测还不是在手术期间降低阿片类药物消耗的可靠方法.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 手术护理 手术护理
背景情况:
- 在手术期间的感觉被测量使用感觉水平 (NOL) 指数,来自生理信号.
- 传统治疗包括在临床医生的裁量权下给予阿片类药物.
- 需要客观措施来指导手术内止痛的必要性至关重要.
研究的目的:
- 系统地审查和元分析随机临床试验,比较NOL导向阿片类药物给药与传统治疗.
- 评估NOL监测在减少手术内阿片类药物消费方面的有效性.
主要方法:
- 在PubMed,Scopus和CENTRAL数据库中系统搜索相关的随机临床试验.
- 对9项涉及519名接受各种手术的成年患者的试验的元分析.
- 主要结局:通过标准化平均差异 (SMD) 测量手术期间的阿片类药物消耗.
- 随机效应模型采用Hartung-Knapp-Sidik-Jonkman调整;使用I2统计和预测间隔评估异质性.
- 使用GRADE准则评估的证据确定性.
主要成果:
- 整体手术内阿片类药物消费显示非显著的标准化平均差异 (SMD) 为 -0.26 (95% CI, -0.82至0.30; P = .31).
- 观察到大量的临床和统计异质性 (I2 = 86%).
- 未来研究的预测间隔从-1.95到1.42不等.
- 证据的确定性被认为是低的.
结论:
- 目前的证据不支持常规使用NOL监测来减少手术期间的阿片类药物消费.
- 可能需要进一步研究高质量的试验,以澄清NOL监测的作用.
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