帕瑞昔布術后臨床鎮痛效果和安全性的Meta分析_《中國循證醫學雜志》

作者：

李曉倩 ¹ , 孫捷豪 ² ,  馬虹 ¹

1. 中國醫科大學附屬第一醫院麻醉科（沈陽?110001）；2. 溫州醫學院附屬第一醫院麻醉科（溫州?325000）;

關鍵詞：

帕瑞昔布疼痛環氧化酶-2抑制劑 Meta分析

DOI：

10.7507/1672-2531.20090156

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目的　系統評價帕瑞昔布用于術后臨床鎮痛的效果及安全性。
方法　電子檢索PubMed、EBSCO、Springer、Ovid、CNKI等數據庫，收集1999～2009年發表的關于患者自控鎮痛（PCA）聯合帕瑞昔布術后鎮痛的隨機對照試驗（RCT），按Cochrane系統評價的方法評價納入研究的質量和提取資料，并采用RevMan軟件進行統計分析。
結果　共納入7個RCT，包括1 939例患者。Meta分析結果顯示：① 有效性：PCA聯合術后短期靜注帕瑞昔布鎮痛，初始給藥后24、48和72 h，患者對鎮痛效果滿意度評分“有效”率均高于單用PCA［RR（95%CI）分別為1.41（1.13，1.75），1.25（1.15，1.35），1.30（1.21，1.40）］，“無效”率均低于單用PCA［RR（95%CI）分別為0.43（0.26，0.72），0.44（0.34，0.57），0.33（0.23，0.48）］。② 安全性：PCA聯合帕瑞昔布能減少患者術后發熱［RR=0.34，95%CI（0.22，0.53）]、惡心嘔吐［RR=0.69，95%CI（0.57，0.83）］的發生率，但在減少患者呼吸抑制［RR=0.84，95%CI（0.38，1.83）］、瘙癢癥［RR=0.91，95%CI（0.54，1.52）］、頭疼［RR= 0.77，95%CI（0.47，1.28）］方面與單用PCA的差異無統計學意義。
結論　PCA聯合術后短期靜注帕瑞昔布能明顯提高患者對術后鎮痛的滿意程度，且不增加阿片類藥物的不良反應，并可減少術后發熱及惡心嘔吐。

引用本文： 李曉倩,孫捷豪,馬虹. 帕瑞昔布術后臨床鎮痛效果和安全性的Meta分析. 中國循證醫學雜志, 2009, 09(8): 887-892. doi: 10.7507/1672-2531.20090156 復制

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2.	Gierse JK, McDonald JJ, Hauser SD, et al. A single amino acid difference between cyclooxygenase-1 (COX-1) and -2 (COX-2) reverses the selectivity of COX-2 specific inhibitors. J Biol Chem, 1996, 271(26): 15810-15814.
3.	Apfelbaum JL, Desjardins PJ, Brown MT, et al. Multiple-day efficacy of parecoxib sodium treatment in postoperative bunionectomy pain. Clin J Pain, 2008, 24(9): 784-792.
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5.	Viscusi ER, Gimbel JS, Halder AM, et al. A multiple-day regimen of parecoxib sodium 20 mg twice daily provides pain relief after total hip arthroplasty. Anesth Analg, 2008, 107(2): 652-660.
6.	Tang J, Li S, White PF, et al. Effect of parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor, on the postoperative opioid requirement and quality of pain control. Anesthesiology, 2002, 96(6): 1305-1309.
7.	Malan TP, Marsh G, Hakki SI, et al. Parecoxib sodium, a parenteral cyclooxygenase-selective inhibitor, improves morphine analgesia and is opioid-sparing following total hip arthroplasty. Anesthesiology, 2003, 98: 950-957.
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11.	Mehlisch DR, Desjardins PJ, Daniels S, et al. The analgesic efficacy of intramuscular parecoxib sodium in postoperative dental pain. J Am Dent Assoc, 2004, 135(11): 1578-1590.
12.	Gan TJ, Joshi GP, Zhao SZ, et al. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand, 2004, 48(9): 1194-1207.
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1. Bensen WG, Fiechtner JJ, McMillen JI, et al. Treatment of osteoarthritis with celecoxib, a cyclooxygenase-2 inhibitor: a randomized controlled trial. Mayo Clin Proc, 1999; 74: 1095-1105.
2. Gierse JK, McDonald JJ, Hauser SD, et al. A single amino acid difference between cyclooxygenase-1 (COX-1) and -2 (COX-2) reverses the selectivity of COX-2 specific inhibitors. J Biol Chem, 1996, 271(26): 15810-15814.
3. Apfelbaum JL, Desjardins PJ, Brown MT, et al. Multiple-day efficacy of parecoxib sodium treatment in postoperative bunionectomy pain. Clin J Pain, 2008, 24(9): 784-792.
4. Michael C, Artur J, Kotarski J, et al. Parecoxib sodium administered over several days reducespain after gynecologic surgery via laparotomy. J Clin Anesth, 2007, 19: 448-455.
5. Viscusi ER, Gimbel JS, Halder AM, et al. A multiple-day regimen of parecoxib sodium 20 mg twice daily provides pain relief after total hip arthroplasty. Anesth Analg, 2008, 107(2): 652-660.
6. Tang J, Li S, White PF, et al. Effect of parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor, on the postoperative opioid requirement and quality of pain control. Anesthesiology, 2002, 96(6): 1305-1309.
7. Malan TP, Marsh G, Hakki SI, et al. Parecoxib sodium, a parenteral cyclooxygenase-selective inhibitor, improves morphine analgesia and is opioid-sparing following total hip arthroplasty. Anesthesiology, 2003, 98: 950-957.
8. Jirarattanaphochai K, Thienthong S, Sriraj W, et al. Effect of parecoxib on postoperative pain after lumbar spine surgery. Spine, 2008, 33: 132-139.
9. Hubbard RC, Naumann TM, Traylor L, et al. Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia. Br J Anaesth, 2003, 90(2): 166-172.
10. Barton SF, Langeland FF, Snabes MC, et al. Efficacy and safety of intravenous parecoxib sodium in relieving acute post-operative pain following gynecologic laparotomy surgery. Anesthesiology, 2002, 97: 306-314.
11. Mehlisch DR, Desjardins PJ, Daniels S, et al. The analgesic efficacy of intramuscular parecoxib sodium in postoperative dental pain. J Am Dent Assoc, 2004, 135(11): 1578-1590.
12. Gan TJ, Joshi GP, Zhao SZ, et al. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand, 2004, 48(9): 1194-1207.
13. Leykin Y, Casati A, Rapotec A, et al. Comparison of parecoxib and proparacetamol in endoscopic nasal surgery patients. Yonsei Med J, 2008, 49: 383-388.

《中國循證醫學雜志》

帕瑞昔布術后臨床鎮痛效果和安全性的Meta分析

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《中國循證醫學雜志》

帕瑞昔布術后臨床鎮痛效果和安全性的Meta分析

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