腹横肌平面阻滞用于剖宫产术后镇痛的效果评价:Meta分析

目的 采用Meta分析的方法评价腹横肌平面阻滞(transversus abdominis plane block,TAPB)在剖宫产术后镇痛的安全性及有效性. 方法 检索PubMed 、OVID、EMBASE、Cochrane图书馆,检索时间从建库至2015年3月.收集剖宫产术后镇痛使用TAPB的随机对照临床试验.采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan5.2软件进行Meta分析. 结果 共纳入12项研究,包括663例患者,其中TAPB组342例,对照组321例.与对照组比较,TAPB组患者术后12h活动时VAS评分明显降低[加权均数差(weighted mean difference,WMD)=-0.61,95％置信区间(confidence interval,CI):-1.13～-0.09,P＜0.05]、术后24 h吗啡累积消耗量减少(WMD=-22.78,95％CI:-24.49～-21.07,P＜0.05)以及TAPB组患者需首次给予补救镇痛的时间延长(WMD=148.22,95％CI:86.57～209.86,P＜0.05),并且TAPB组患者恶心呕吐[比值比(OR)=0.23,95％CI:0.12～0.44,P＜0.05]及过度镇静(OR=0.29,95％CI:0.12～0.67,P＜0.05)的发生率较低. 结论 TAPB可能是剖宫产患者术后镇痛的一种较好的选择.

Effectiveness of transversus abdominis plane block for postoperative analgesia after caesarean section: a Meta-analysis

Objective To evaluate the efficacy of transversus abdominis plane block (TAPB) for postoperative analgesia after caesarean section.Methods We searched the PubMed,OVID,EMBASE,Cochrane library,for all randomized controlled trials about the efficacy of TAPB.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Metaanalysis was conducted using the Cochrane Collaboration's RevMan 5.2 software.Results We identified 12 randomized controlled trials finally.In these studies,there were 663 patients in total,of whom 342 patients received TAPB,321 patients were in the control group.TAPB was found to reduce morphine consumption at 24 h [weighted mean difference (WMD)=-22.78,95％confidence interval (CI):-24.49-21.07,P＜0.05] and VAS scores with activity at 12 h(WMD=-0.61,95％CI:-1.13-0.09,P＜0.05) and TAPB prolonged the time to the first request for analgesic(WMD=148.22,95％CI:86.57-209.86,P＜0.05).In addition,TAPB was found to reduce the incidence of postoperative nausea and vomiting (OR=0.23,95％CI:0.12-0.44,P＜0.05) and sedation (OR=0.29,95％CI:0.12-0.67,P＜0.05).Conclusions TAPB may be a better alternative analgesia technology for the patients who underwent caesarean section.