硬膜外镇痛对肠道手术预后影响的Meta分析_《中国循证医学杂志》

作者：

夏海发 , 任许利 , 王韶双 ,  吕黄伟

中国医科大学附属第一医院麻醉科（沈阳?110001）;

关键词：

硬膜外镇痛肠道手术 Meta分析

DOI：

10.7507/1672-2531.20110158

视频：

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目的　系统评价硬膜外镇痛对肠道手术预后的影响。
方法　计算机检索PubMed、EBSCO、Springer、Ovid、CNKI和CBM数据库，纳入1985～2010年间发表的关于肠道手术应用硬膜外镇痛对术后胃肠功能影响的随机对照试验（RCT），按Cochrane系统评价方法对纳入文献进行资料提取和质量评价，而后采用RevMan 5.0软件进行Meta分析。
结果　共纳入10个RCT，包括506例患者。纳入RCT质量均为C级。Meta分析结果显示：硬膜外自控镇痛与传统静脉自控镇痛相比，术后首次排气、首次排便和住院时间均缩短［MD（95%CI）分别为–1.07（–1.63，–0.50）、–0.63（–1.19，–0.08）和–1.36（–2.28，–0.44）］。术后第1和第2天呕吐发生率降低［OR（95%CI）分别为0.33（0.13，0.82）和0.32（0.13，0.84）］。术后第1、2和3天静息痛VAS［MD（95%CI）分别为–26.60（–33.06，–20.15）、–25.98（–30.98，–20.97）和–15.59（–27.29，–3.88）］，运动痛VAS［MD（95%CI）分别为–26.00（–36.00，–16.00）、–27.89（–35.70，–20.08）和-11.79（–21.28，–2.30）］均明显降低。而在术后尿道感染、尿潴留、吻合口漏和肠梗阻发生率方面，两者间差异无统计学意义。
结论　肠道手术术后应用硬膜外自控镇痛较之传统静脉自控镇痛能明显缩短首次排气、排便和术后住院时间，且能明显降低术后疼痛VAS，降低术后呕吐发生率。但本研究纳入RCT质量均低，样本量小，结论尚需大规模高质量RCT证实。

引用本文： 夏海发,任许利,王韶双,吕黄伟. 硬膜外镇痛对肠道手术预后影响的Meta分析. 中国循证医学杂志, 2011, 11(8): 946-953. doi: 10.7507/1672-2531.20110158 复制

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, 赵道霞. PCIA 与PCEA 对下腹部手术后患者功能恢复影响的对比研究. 山西医科大学学报, 2007, 38(9): 842-844.
17.	徐红梅, 张跃, 钱燕宁. 贲门癌根治术中两种麻醉镇痛方案对病人术后康复的影响及其医疗费用比较. 实用临床医药杂志, 2008, 12(7): 37-42.
18.	洪溪, Carli F, 黄宇光, 等. 手术及镇痛方式对肠道手术后功能恢复的影响. 临床麻醉学杂志, 2006, 22(5): 334-336.
19.	王刚, 江志伟, 沈蓓, 等. 胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛和肠功能的影响. 医学研究生学报, 2010, 23(8): 830-833.
20.	刘建湘, 刘新光. 外科手术后的胃肠动力障碍. 中国实用内科杂志, 2001, 21(10): 591-593.
21.	刘志双, 李星, 刘顺锁, 等. 剖宫产手术后硬膜外腔持续镇痛效果及对泌乳和肠蠕动的影响. 中华麻醉学杂志, 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, 赵道霞. PCIA 与PCEA 对下腹部手术后患者功能恢复影响的对比研究. 山西医科大学学报, 2007, 38(9): 842-844.
17. 徐红梅, 张跃, 钱燕宁. 贲门癌根治术中两种麻醉镇痛方案对病人术后康复的影响及其医疗费用比较. 实用临床医药杂志, 2008, 12(7): 37-42.
18. 洪溪, Carli F, 黄宇光, 等. 手术及镇痛方式对肠道手术后功能恢复的影响. 临床麻醉学杂志, 2006, 22(5): 334-336.
19. 王刚, 江志伟, 沈蓓, 等. 胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛和肠功能的影响. 医学研究生学报, 2010, 23(8): 830-833.
20. 刘建湘, 刘新光. 外科手术后的胃肠动力障碍. 中国实用内科杂志, 2001, 21(10): 591-593.
21. 刘志双, 李星, 刘顺锁, 等. 剖宫产手术后硬膜外腔持续镇痛效果及对泌乳和肠蠕动的影响. 中华麻醉学杂志, 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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硬膜外镇痛对肠道手术预后影响的Meta分析

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《中国循证医学杂志》

硬膜外镇痛对肠道手术预后影响的Meta分析

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