国内芬太尼透皮贴剂与口服吗啡控释片治疗中重度癌痛临床随机对照试验的Meta分析

目的：通过Meta分析，探讨国内芬太尼透皮贴剂与口服吗啡控释片在癌痛治疗中的临床应用价值。方法：检索中国生物医学文献库（CBMdisc）、中国期刊全文数据库、维普数据库（VIP）等国内数据库已发表的相关文献，收集国内有关芬太尼透皮贴剂与口服吗啡控释片治疗癌痛的随机临床对照试验（randomized controlled trials，RCTs），由两位评价者分别按检索策略收集并按纳入标准入选资料，分析指标为疼痛缓解率和毒副反应发生率。结果：12个研究共911例患者纳入分析，芬太尼透皮贴剂与口服吗啡控释片的疼痛缓解率分别是87．32％和89．14％（P=0．79）；在不良反应方面，芬太尼透皮贴剂相比口服吗啡控释片便秘的发生率降低31％（P〈0．00001），恶心呕吐的发生率降低26％（P=0．0002），头晕嗜睡的发生率降低10％（P=0、02）。结论：芬太尼透皮贴剂和口服吗啡控释片治疗中重度癌痛的效果相近，但芬太尼透皮贴剂不良反应的发生率可能较低，临床医生应根据患者个体情况合理选用。

Fentanyl transdermal or sustained-release oral morphine in the treatment of Chinese with moderate-to-severe cancer pain:a meta-analysis of RCTs

Objective： To evaluate the clinical value of fentanyl transdermal and oral morphine in the treatment of Chinese with cancer pain by meta-analysis. Methods： To search all of the randomized clinical trials （RCTs） on fentanyl transdermal and oral morphine in the treatment of patients with cancer pain in domestic electronic databases including CBMdisc,CNKI and VIP. Two reviewers collected information based on index strategy and inclusion criteria. Analysis index were remission rate of pain and incidence of adverse events. Results：The meta-analysis included 12 trials, 911 cases. Remission rate of pain in fentanyl transdermal and oral morphine were 87. 32% and 89.14% （P = 0. 79）. There were significant difference in incidence of constipation RD = - 0. 31, 95% CI （ - 0. 41, -0. 21 ）, P 〈0. 000 01 ] ,vomiting/nausea RD = -0. 26, 95% CI（ -0. 39, -0. 12）, P =0. 000 2] ,dizziness/drowsiness RD = -0. 10, 95% CI （ -0. 18, -0. 02）, P =0.02] between fentanyl transdermal and oral morphine. Conclusion： Both fentanyl transdermal and oral morphine had the same effect in the treatment of patients with moderate-to-severe cancer pain, but the former might have lower incidence of adverse reaction, clinician should choose the drug based on individual patient＇s condition.