适用于微创腹部手术的无阿片类麻醉:系统性审查,元分析和试验顺序分析
Carlos A B da Silveira1, Ana C D Rasador2, Heitor J S Medeiros3
1Dignity Health St. Joseph's Hospital, Phoenix, AZ, USA.
Canadian journal of anaesthesia = Journal canadien d'anesthesie
|November 5, 2024
概括
无阿片类药物麻醉可显著减少手术后恶心和吐 (PONV) 和在微创腹部手术中消耗阿片类药物. 这种方法为传统的阿片类麻醉提供了可行的替代方案,改善了患者的治疗结果.
科学领域:
- 麻醉学 麻醉学
- 手术瘤学手术瘤学
- 药理学 药理学是指药理学的学科.
背景情况:
- 阿片类麻醉是最小侵入性手术的标准,但会引起像术后恶心和吐 (PONV) 这样的副作用.
- 无阿片类药物麻醉被探索为一种减少这些不良事件的策略.
- 这项研究侧重于微创腹部手术.
研究的目的:
- 系统地审查,元分析和试验顺序分析 (TSA) 无阿片类麻醉与阿片类麻醉的疗效.
- 为了比较包括PONV和心等主要结局.
- 评估二次结果,如疼痛,阿片类药物消费和麻醉后护理单位 (PACU) 停留时间 (LOS).
主要方法:
- 进行了随机对照试验 (RCT) 的系统审查和元分析.
- 搜索的主要数据库:科克兰控制试验中央注册表,MEDLINE和Embase.
- 利用试验序列分析 (TSA) 来评估关键结果的证据确定性.
主要成果:
- 包括26个RCT,包括2025名患者;49%接受了无阿片类药物麻醉.
- 无阿片类药物麻醉显著降低了PONV (RR0.55,P<0.001) 和手术内阿片类药物消耗.
- 胸或PACU LOS没有显著差异;无阿片类药物麻醉显示出降低疼痛得分的趋势,并缩短了第一次止痛的时间.
结论:
- 无阿片类药物麻醉在减少PONV和在微创腹部手术中早期术后阿片类药物需求方面是有效的.
- 这种方法为传统的阿片类麻醉提供了安全有效的替代方案.
- 运输安全局证实,对PONV减少发现的样本大小足够.
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