曲马多联合氯诺昔康术后静脉自控镇痛疗效与安全性的Meta分析

目的 系统评价曲马多联合氯诺昔康用于术后病人静脉自控镇痛（PCA）的临床疗效和安全性.方法 计算机检索PubMed、Embase、Cochrane图书馆、CNKI、维普VIP等数据库,收集曲马多联合氯诺昔康联合用药用于术后镇痛的临床研究文献,采用RevMan 5.0软件进行Meta分析.结果 共纳入8项临床试验,518例患者.Meta分析结果显示：（1）VAS评分：联合用药组术后12、24、48 h患者的VAS评分较曲马多组低,且有统计学差异[WMD=-0.69,95%CI（-1.26,-0.12）,WMD=-1.09,95%CI （-1.63,-0.55）,WMD=-0.57,95%CI（-0.80,-0.35）];与氯诺昔康组在各时间点VAS评分无明显差异;（2） PCA有效按压次数：联合用药组术后12、24、48 h 的PCA有效按压次数无明显差异;（3） 不良反应：联合用药组恶心呕吐、眩晕等不良反应发生率降低.结论 术后PCA将曲马多与氯诺昔康联合能得到满意的临床镇痛效果,同时能够降低不良反应发生率.

Meta-analysis of efficacy and security of tramadol combined with lornoxicam for patient-controlled analgesia

Objective To evaluate the efficacy and security of tramadol combined with lornoxicam for patient-controlled analgesia （ PCA）, so as to provide evidence for rational drug use in clinic. Methods The randomized controlled trials of tramadol combined with lornoxicam for PCA were gathered from PubMed, Embase, and Cochrane database of Systematic Reviews, CNKI and VIP. The data analy-ses were performed with The Cochrane Collaboration＇ s software RevMan 5. 0. Results 8 RCTs were included with a total of 518 cases. The meta-analysis results showed as follows：as for visual analog scale （VAS） score, compared with the tramadol group, the postoperative VAS at 12-hour,24-hour and 48-hour was decreased in the combined drug group [ WMD = -0.69,95% CI （ - 1.26 to -0.12） ;WMD = - 1.09,95 % CI （ - 1.63 to - 0. 55 ） ; WMD = - 0.57,95% CI （ - 0.80 to - 0.35 ） ] ; but there were no significant differences com- pared with lornoxicam group. As for number of bolus applications of PCA, there was no significant difference at 12-hour,24-hour and 48-hour. Incidence of adverse reactions in the combination group, compared with the single drug group, such as nausea, vomiting, dizziness, was significantly reduced. Conclusion Tramadol combined with lornoxicam for PCA can effectively alleviate postoperation pain com- pared with single drug group, and can be able to reduce the incidence of adverse reactions.