经静脉与硬膜外两种自控镇痛方式效果的系统评价

目的系统评价术后经静脉与硬膜外自控镇痛的镇痛、镇静效果和不良反应。方法计算机检索Cochrane图书馆（2008年第9期）、Cochrane协作网麻醉组专业协作组数据库、MEDLINE（1966-2008．9）、EMbase（1966～2008．9）、PubMed（1966～2008．9）、中国生物医学文献数据库（1979～2008．9）、CNKI；手工检索《中华麻醉学杂志》、《临床麻醉学杂志》及国内外相关会议论文，收集术后经静脉与硬膜外自控镇痛的随机和半随机对照试验，并评价纳入研究的方法学质量。Meta分析采用RevMan4．2．8软件。结果共纳入13个研究，包括580例患者。Meta分析结果显示，在术后2、4、8、12及24h几个时点，其镇痛、镇静差异均无统计学意义；在镇痛效果相同的情况下，两组血浆芬太尼浓度差异无统计学意义；术后两组不良反应发生率差异亦无统计学意义。结论经静脉自控镇痛和经硬膜外自控镇痛均能得到满意的临床治疗效果。而且经静脉自控镇痛避免了硬膜外穿刺及其并发症的发生，还具有携带方便、操作简单、可减少医疗费用等优点。因本系统评价纳入研究的质量不高，病例数较少，上述结论尚需开展更多设计严谨的大样本随机对照试验加以验证。

Intravenous versus Epidura Patient-Controlled Analgesia for Post-Operation: A Systematic Review

Objective To evaluate the effectiveness of intravenous patient-controlled analgesia versus epidural patient-controlled analgesia for postoperative analgesia, sedation, and the incidence of side effects. Methods We searched the specialized trials registered in the Cochrane anesthesia group, The Cochrane Library （CCTR）, MEDLINE （1966 to Sept. 2008）, EMbase （1966 to Sept. 2008）, PubMed （1966 to Sept. 2008）, and handsearched some Chinese anesthesia Journals and Clinical anesthesia journals. Randomized controlled trials （RCTs） and quasi-RCTs of intravenous versus epidural analgesia for post-operation were included. The quality of the trials was critically assessed. RevMan 4.2.8 software was used for meta-analyses. Results Thirteen RCTs involving for post-operation were included. The results of meta-analyses 580 patients of intravenous versus epidural analgesia showed that there were no significant differences in postoperative analgesia and sedation at the hour-points of 2nd, 4th, 8th, 12th, and 24th hours after operation. There were no significant differences in plasma fentanyl concentration in the two groups on the same analgesia effects. There were also no significant differences in side effects. Conclusion Both intravenous patient-controlled analgesia and epidural patientcontrolled analgesia have the same clinical effects. Compared with epidural patient-controlled analgesia, intravenous patient-controlled analgesia has fewer side effects and is more convenient. At the same time, it can reduce more costs of hospitalization. But because of the low quality and small sample size of the included studies, more well-designed, large scale, randomized controlled trials are needed.